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Full text of "Harvard medical alumni bulletin"

SUMMER 2000 




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When Hardy Jones '73 
retired from orthopedic 
surgery, he turned to sculpture 
as a way to rejuvenate himself 






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Second 
Nature 



Before his death 
in 1 994, Nathan 
Talbot '36 was 
a pediatrician, 
a painter, and 
a photographer. 
Pictured here is 
an example of 



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SUMMER 200 • VOLUME 74, NUMBER 1 



r.ONTFNTS 



DEPARTMENTS 



Letters 3 

Pulse 6 

Upcoming alumni events, a new research 
building, the School's conflict-of-interest 
poHcy, Match Day 

Editorial 11 

Whistleblowing in medicine 
by Thomas 'Najarian 

Bookmark 12 

A review of Doctors Afield 
by Elissa Ely 

Bookshelf :13 

Benchmarks 14 

Newly described symptoms provide 
clues to better migraine therapies. 
by Misia Landau 

Class Notes 58 

InMemoriam 61 

Charles S. Davidson 

Obituaries 62 

Endnotes 64 

The Kingdom of Biotechnology 
ty Paid J. Davis 



SPECIAL REPORT: PHYSICIAN RENEWAL 




Physician, Heal Thyself 16 

For physicians struggling to cope with the current stresses in 
medicine, the search for a cure begins within. 

hy CHARLES J. HATEM 

Finding Home 20 

How does a doctor with one of medicine's most depleting jobs — 
providing health care to the homeless — sustain himself? 

by JAMES J. O'CONNELL 

Striking a Balance 26 

whether in martial arts training, in verse, in prayer, or in fUght, these 
physicians have enriched their practice of medicine. 

by BEVERLY BALLARO 

Second Wind 32 

After decades of treating patients, these doctors retired from medicine 
to pursue new passions: turning hubcaps into warriors, delivering 
homilies to parishioners, and transforming glass into miniature gardens. 

by PHYLLIS L . FAGELL 

Wisdom of the Aged 38 

By drawing on the same techniques that foster successful aging, 
doctors can thrive — and not just survive — in medicine. 

by ERIC B. LARSON 



HJAIIIJJJ 

When HMS Went to War 

In their country's most urgent hour of need, a generation of 
Harvard doctors answered the call to duty. 

by BEVERLY BALLARO 

On the Brink 

In 1939, when the author left for 
Copenhagen on a Harvard 
traveling fellowship, history 
stood poised on the edge of 
events that would change 
the world. 

fc^PAUL C. ZAMECNIK 



Cover photograph: When Hardy 
Jones 73 retired from orthopedic 
surgery, he took up found-metal 
sculpture as a way to renew himself 
Photograph by Robert Holmgren. 



42 




Harvard M edipnl 



A L U M N 



U L L E T I N 




In this Issue 

BEGIN WRITING THIS COLUMN FRESH FROM A MILD DOMESTIC ARGUMENT 

over the (accurate) accusation that I don't get enough exercise — and 
successfully evading a resolution of it with the sweet (and accurate) 
assertion that I need to finish this column or risk further delaying a 
production deadline. Now to avoid being called shameless (also accurately), I'll 
need to keep this issue of the Bulletin out of the house or else agree to an exercise 
plan. (Contrary to popular opinion, hypocrisy is never really the easy way out.) 

"Physician renewal" was an unfamihar term to me until we started work on 
this issue. The phrase is meant to move beyond the more restrictive concept of 
burnout prevention to a broader view of what it means to practice medicine 
creatively, conscientiously, and even joyfully for a working lifetime. There can 
be httle doubt that this task has become considerably more diEicult in the last 
few decades, and not just because of the resource limitations that we lump 
under the term "managed care." Readers of this pubhcation hardly need a 
recitation of the financial, administrative, and human pressures that seem con- 
trived to create a spirit of hopelessness and helplessness. But the worst of it 
seems to be the brute fact that there is more riding on every decision we make. 
Care of the patient still requires caring for the patient, but since Francis Weld 
Peabody coined the aphorism, the technical requirements of care have become 
much more exacting. Given that the amount of care and caring one can deHver 
to patients, community, and self is a zero-sum game, we may need some new 
aphorisms to supplement the old. 

In this issue several distinguished physicians offer precepts and examples for 
renewal in, or beyond, a medical career. The fundamental recommendation, of 
course, is to maintain adequate self-care. As my father, an amateur sailor, would 
say to me in rough weather: "Always keep one hand for yourself and use the 
other one for the vessel." For physicians, this translates to, "Practice what you 
(ought to) preach." Perhaps even more fundamental is the notion from Epictetus 
by way of Victor Frankl as quoted by Charles Hatem — and perhaps exemplified 
by James O'Connell — in these pages: Retain the freedom to choose your attitude. 

But as Dr. O'Connell points out, one does not choose one's attitude in a vac- 
uum. This issue adopts a very personal stance toward the task of renewal, yet 
more, much more, needs to be written about what we as physicians can do 
collectively and systemically to renew the meaning of medical practice in ways 
sustainable for the long term. I trust that the Bulletin will return to this topic. 



EDITOR-IN-CHIEF 

William Ira Bennett '68 

EDITOR 

Paula Brewer Byron 

ASSOCIATE EDITOR 

Phyllis L. Fagell 

ASSISTANT EDITOR 

Beverly Ballaro, PhD 

BOOK REVIEW EDITOR 

ElissaEly'88 



Ul^h&M\ l/U ^U/v-^ 



EDITORIAL BOARD 

Elissa Ely '88 

Robert M. Goldwyn '56 

Joshua Hauser '95 

Paula A. Johnson '84 

Perri Klass '86 

Victoria McEvoy '75 

James J. O'Connell '82 

Gabriel Octerman '91 

Deborah Prothrow-Stith '79 

GuQlermo C. Sanchez '49 

J. Gordon Scannell '40 

Joshua Sharfstein '96 

Eleanor Shore '55 
John D. Stoeckle '47 

DESIGN DIRECTOR 

Laura McFadden 

ASSOCIATION OFFICERS 

Sharon B. Murphy '69, president 
Charles J. Hatem '66, president-elect 1 

Paul J. Davis '63, president-elect 2 

Stephen G. Pauker '68, vice president 

Maria C. Alexander-Bridges '80, secretary 

James B. Field '51, treasurer 

COUNCILLORS 

Claire V. Broome '75 

Paul Farmer '90 

B. Lachlan Forrow '83 

Michael A. LaCombe '68 

Eric B. Larson '73 

Gina Moreno-John '94 

DeborahJ. Oyer'87 

DeWayne M. Pursley '82 

Morton N. Swartz '47 
Nanette Kass Wenger '54 

DIRECTOR OF ALUMNI RELATIONS 

Daniel D. Federman '53 

ASSISTANT DEAN FOR ALUMNI 
AFFAIRS AND SPECIAL PROJECTS 

Nora N. Nercessian, PhD 



REPRESENTATIVE TO THE 
HARVARD ALUMNI ASSOCIATION 

Chester d'Autremont '44 



The Harvard Medical Atumni Bulletin is 

published quarterly at 25 Shattuck Street, 

Boston, MA 02115 f by the Harvard 

Medical Alumni Association. 

Phone: (617) 432-1548 . Fax: (617) 432-0013 

Email: bullecin@hms.harvard.edu 

Third class postage paid at Boston, 

Massachusetts. Postmaster, send form 3579 

to 25 Shattuck Street, Boston, MA 02115 

ISSN 0191-7757 • Printed in the U.S.A. 



HARVARD MEDICAL ALUMNI BULLETIN • SUMMER 2000 



SECOND OPINIONS FROM OUR READERS 



LKTTKHS 



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BUNDLE OF JOY 

Your recent issue with 
the httle baby in the 
hands, presumably, of a 
physician or the father, 
is a winner! You should 
be very proud. 

FRANCIS D. MOORE, SR. '39 
WESTWOOD, MASSACHUSETTS 



Judging by Its Cover 



The cover of the winter issue of the 
Bulletin really caught my attention. It 
was so well-done! 

MAUREEN MURPHY 
BOSTON, MASSACHUSETTS 

Respecting Final Wishes 

I was struck by the beauty of the 
thought-provoking photograph on the 
cover of the winter issue, and I found 
the articles enormously interesting. The 
article on assisted reproductive tech- 
nologies, "Small Wonders," was fasci- 
nating, as were the articles on physi- 
cian-assisted suicide. I am 83 and have a 
living will, so end-of-life-care issues are 
important to me. Too often, I find, a sick 
person's wishes about his or her death 
are not carried out. 

ELIZABETH ZIMMERMANN 

(WIDOW OF BERNARD ZIMMERMANN '45) 

WESTWOOD, MASSACHUSETTS 

Matters of Life and Death 

Congratulations! The winter issue is the 
most trenchant you have ever pub- 
lished. All U.S. congressmen and sena- 
tors should read Dr. Peter Patricelli's 
description of his experiences with 
physician- assisted suicide, so that, as 
they consider the so-called "Pain Relief 
Promotion Act of 1999," they may have 



an appreciation of what real-life choices 
are being made every day throughout 
the country. 

Part of the appeal and effectiveness of 
the issue are the wonderful pho- 
tographs, especially the very moving 
one on its cover. I hope you will tell us 
in the next issue who created these 
touching images. 

NORMAN J. SISSMAN '50 
PRINCETON, NEW JERSEY 



Editor's note: We have received an over- 
whelming response to the images in the 
winter issue, especially the photograph on 
the cover and those featured in "Small 
Wonders." The cover shot, "Jack Holding 
Ariana," was taken by Aane Geddes, an 
internationally known photographer. 
Geddes, who is based in New Zealand, 
graciously allowed us to run the photo- 
graph without a fee. The photographs in 
"Small Wonders" were taken by Boston 
photographer Michele McDonald, who 
chronicled the earhest days of Harry, a 
baby born ten weeks early. 

The Healing Arts 

The winter issue was most thought pro- 
voking. It highlighted the problem pre- 
sented to all who practice medicine in 
this age: the problem of ethics. Unfortu- 
nately, this is a very poorly defined sub- 
ject. Concise definitions cannot be found 
in dictionaries or encyclopedias. It 
becomes apparent that ethical standards 
are influenced by many factors and are 
subject to variations according to time 
and cultural environment. 

Perhaps ethics are the rules that deter- 
mine what is right and what is wrong. 




SUMMER 2000 • HARVARD MEDICAL ALUMNI BULLETIN 




T.ETTERS 



SECOND OPINIONS FROM OUR READERS 



But this does not help because what is 
right is subject to varying interpreta- 
tions. What is right for an individual may 
be wrong for the society as a whole. In 
the practice of the healing arts, we are 
taught to put our responsiblhty for the 
individual patient first. But do we not 
also have a responsibility to society as a 
whole? The two may be in conflict. If we 
spend an inordinate amount of our time, 
money, and persormel on one patient, we 
may deprive others of the care they need. 
The doctrine of non nocerc is not clear- 
cut, because saving or helping one 
patient may lead to harming someone 
else, though this may not be apparent at 
the time. The use of ethics committees 
may shift the responsibility for deci- 
sions from the individual practitioner, 
but it can also complicate matters. 
Sometimes the patient's health care 
provider, who has known all the cir- 
cumstances in a way that a consulting 
committee cannot, is in a better position 
to make the hard decisions. The old- 
fashioned family physician often made 
the wisest decisions for the benefit of 
all concerned and was rarely second- 
guessed by well-meaning busybodies. 

NEVILLE K. CONNOLLY '44 
FAIRFAX STATION, VIRGINIA 



Spreading the Word 

A friend was kind enough to share a 
copy of the issue on medical ethics, and 
not only is the cover enchanting, but all 
the articles are so important. There is a 
tremendous need for wider distribution 
of the articles printed, and I only wish 
we could figure out a way to spread this 
issue further into the community. 

MARY S. STRONG 
V/ESTWOOD, MASSACHUSETTS 

On the Money 

In the excellent "Medical Ethics" issue, 
James E. Sabin '64 wrote in "Slicing the 
Pie" that our patients can help us deal 
with the ethical problems that arise 
when resources are limited. Fine. But 
we should also consider how rethink- 
ing the size of the pie and the way we 
distribute the slices could ameliorate 
the ethical problems of the individual 
physician. 

First, the size of the pie. America 
now spends roughly $1.2 trillion a year 
on health care, about half of that by 
government, both state and federal. 
Because the other half is spent by the 
private sector, largely by insurance 
companies whose sole financial respon- 
sibility is to maximize profit for their 




shareholders, there has not been a 
national debate on just how much we 
should be spending on health care. A 
provocative public policy question 
might be: even though we spend twice 
as much per capita as any other country, 
perhaps, with 44 million Americans 
uninsured, we should be spending more, 
not less. Should we not at least be talk- 
ing about what is appropriate and feasi- 
ble for the richest country in world his- 
tory in an age of exploding, spectacular, 
and expensive medical technology? 

A comparison with another public 
policy area is striking. For the military, 
which gets an extraordinary percentage 
of our tax dollars, there is a rough con- 
sensus that we spend "whatever is nec- 
essary." There was debate on the tight- 
ness of the Gulf and Kosovo wars, but 
their costs were neither specifically 
scrutinized nor debated. Moreover, for 
better or worse, there has been main- 
stream acceptance of increases in our 
$900-million-a-day military spending. 
In stark contrast, there has been scant 
consideration given to the ethical/pub- 
lic policy position that we spend "what- 
ever is necessary" on health care. 

Second, ethical pressures could be 
eased by making more effective use of 
the slices of the existing pie. A few 
years ago, the Congressional Budget 
Office estimated that the administra- 
tive savings of reducing the number of 
payers from 1,500 to one — the govern- 
ment — would be $100 billion a year. 
Moreover, HMOs currently squander 
25 to 30 percent of their premiums on 
advertising, administration, executive 
salaries, and profit. Meanwhile, Medi- 
care spends only 2 to 3 percent on 
administration. Even at present spend- 
ing levels, universal Medicare would be 
a more rational and less wasteful sys- 
tem, which could ease the ethical prob- 
lems of resource choice. 

National health insurance would have 
another huge ethical benefit. It would 
ehminate the nefarious HMO practice of 
rewarding doctors for gi^'ing less care 
and punishing them for giving "too 



HARVARD MEDICAL ALUMNI BULLETIN • SUMMER 2000 



Slicing 



when limited heallii care resou 
muit be divided, pahents oFten n 
l^eir sense of Toimeu 



InoN TOR f. thrccmoneh sabbicic.il to srudy 
[he «clijcs oF resource aJlocaciun in the 
National Health Setvicc. the issues I was invcs- 
Dgating hit the front page. The morning news- 
paper heaiJIine rcaii. "Leukemia Girl Loses 
Coute Fight.- 

Five years earlier. Jaymee Bowen. loiown at 
the time as -Child B.' had developed noo 
Hodgkln's lymphoma at age sue In December 
I99J, Jaymee 



a,forv 



4. The leukemia 



by James E. Sabin 




much." This is profoundly unethical 
reverse fee-splitting that our profession 
should not tolerate. 

Medical ethics problems and solutions 
are inseparable from public policy deci- 
sions. Therefore, all those concerned 
about medical ethics must enter the fray 
of public debate. 

JAMES S. BERNSTEIN '52 
ROCKVILLE CENTRE, NEW YORK 

A Way with Words 

I want to thank William Bennett, edi- 
tor-in-chief, for his wonderful column 
in the winter issue of the magazine. It 
shines with his intelligence, breadth of 
understanding, liveliness, and wonder- 
ful balance between humility and forth- 
rightness. And it is beautifully written. 

LESTON HAVENS, MD 
CAMBRIDGE, MASSACHUSETTS 

One Diagnosis Does Not Fit All 

The winter issue presented some inter- 
esting news of the investigations by 
members of the child and adolescent 
psychiatry group at Massachusetts 
General Hospital on the perplexing 
problem of attention deficit hyperac- 
tivity disorder (ADHD). Ms. Strobel 
mentioned in particular the group's 



work with drugs, brain imaging, and 
genetic factors. 

Equally pertinent, but perhaps less 
newsworthy, are the efforts of some 
pediatric graduates of HMS, who are 
trying to clarify the various conditions 
now being lumped together under the 
broad diagnosis of ADHD. Much of the 
present confusion in the research in this 
area has been generated by the use of 
one convenient diagnostic label to 
describe an extensive range of varia- 
tions, dysfunctions, and disabilities in 
many different kinds of children. In 
Chapel Hill, North Carolina, Melvin D. 
Levine '66 has for years urged replacing 
the single label of ADHD with a more 
comprehensive and dimensional evalua- 
tion of the child's specific strengths and 
weaknesses. Instead of using one diag- 
nosis and one treatment for all, the man- 
agement can then be adjusted to the 
cognitive, temperamental, and adapta- 
tional needs of the particular child. 

I have suggested, not only at the NIH 
Consensus Conference on the Diagnosis 
and Treatment of ADHD in November 
1998, but elsewhere as well, that there 
are major problems with the diagnostic 
criteria for ADHD. These problems 
include the fact that the designated 



ADHD behaviors are not distinguish- 
able from normal temperament varia- 
tions; the absence of clear evidence that 
the ADHD behaviors are related to brain 
malfunction; the neglect of the role of 
the environment in causing the symp- 
toms of dysfunction; and the vague and 
highly subjective criteria used on the 
current diagnostic questionnaires. A 
better evaluation scheme along the lines 
suggested by Dr. Levine would go a long 
way toward eliminating the present 
confusion about who is being included 
in studies. 

Investigations of drug treatment, 
brain imaging, and genetic origins will 
be inconclusive as long as the conditions 
being studied are not clearly defined. 
Meanwhile, users of cerebral stimulants 
for ADHD should understand that even 
normal children function better with 
them, and that an improvement during 
administration is no proof that a brain 
disorder is being treated. 

Let us be optimistic, but let us also 
recognize that we have a long way to go. 

WILLIAM B. CAREY '54 
SWARTHMORE, PENNSYLVANIA 

History Taking 

"Cures by Epicures" in the winter issue 
is read with delight! It is appropriate 
that the editor have the last word in 
this significant edition. The issue 
rounds out this history of Fannie 
Farmer's association with HMS very 
nicely with "Glorious Deeds" by my 
HMS classmate, John Bunker '45, with 
whom I served an accelerated surgical 
internship at Massachusetts General 
Hospital, and "Mind and Body" by 
Eugene Taylor and "Taking the Cure" by 
John Stoeckle '47. 

ROBERT S, SHAW '45 

NEW IPSWICH, NEW HAMPSHIRE 

The Bulletin welcomes letters to the editor. Please 
send letters by mail (Harvard Medical Alumni 
Bulletin, 25 Shattuck Street, Boston, Massachu- 
setts 02U5): fax (6J7-432-00J3); or email (bul 
letin(<Phms. hanard.edu). Letters may he edited for 
length or clarity. 



SUMMER 2000 • HARVARD MEDICAL ALUMNI BULLETIN 



ptit.se 



I MAKING THE ROUNDS AT HMS 




HMS at the Millennium 

t,: OR THE FIRST TIME, THE ALUMNI 

Pjl council is inviting all 8,500 
alumni to a two-day seminar 
on research, education, and 
clinical medicine. The event, called "HMS 
at the Millennium: What's New & What's 
Happening In and Around the Quadran- 
gle," is planned for October 20 and 21 and 
is designed to strengthen the connection 
between alumni and the School. 

"Our goal is to make it easier for alum- 
ni to feel linked to HMS, and to let the 
School know about some of the great 
things our alumni are doing," said semi- 
nar organizer Tenley Albright '61. "We 
also hope many will view this as a good 
chance to catch up with colleagues and 
meet the newest faculty." 

The seminar will feature presenta- 
tions by more than a dozen speakers, 
including Dean Joseph Martin, Jeffrey 
Drazen '72, Daniel Federman '53, Judah 
Folkman '57, Gerald Foster '51, Charles 
Hatem '66, Paula Johnson '84, Philip 
Leder '60, and Eleanor Shore '55. 

The topics wiU vary from computation- 
al genetics to proteomics to mucosal vac- 
cines. Folkman will talk about endostatin; 
Leder will give an update on the newest 
findings in genomics and gene therapy; 



and Foster's speech wiU pose the ques- 
tions, "Could you get into medical school 
now? Could I?" 

To register for the event, for which CME 
credits are available, call Albright at 617- 
247-8202; email her at tenleyl003@aol. 
com; or visit http://www.hms.harvard. 
edu/OnTheThreshold/oct20.html. ■ 

Schweitzer and Bach 

TO COMMEMORATE THE I25TH ANNIVERSARY 

of Albert Schweitzer's birth and the 
250th anniversary of Johannes Sebastian 
Bach's death, physician-musician mem- 
bers of the Longwood Symphony 
Orchestra will perform Bach's music, 
and current and past Schweitzer Fel- 
lows will talk about their experiences in 
Africa and Boston. 

The event will take place October 20 
in the Warren Alpert Building, at the 
end of the first day of the "HMS at the 
Millennium" seminar. It is being co- 
hosted by the Harvard Medical Alumni 
Association and the Albert Schweitzer 
Fellowship. 

Before becoming a doctor, Schweitzer 
"was perhaps the world's leading author- 
ity on Bach near the turn of the century," 
says Lachlan Forrow '83, president of The 
Albert Schweitzer Fellowship. 





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Breaking New Ground 

HMS hopes to break ground this 
fall for construction of a new 
research building on Avenue 
Louis Pasteur adjacent to the Har- 
vard Institutes of Medicine (see 
model). This new facility will 
house the HMS Departments of 
Genetics and Pathology along- 
side research teams from the affil- 
iated hospitals working in areas 
of common scientific interest. The 

building will add 430,000 square feet of space for laboratories and related facil- 
ities. The Harvard Corporation approved the project, estimated to cost $3 1 3 mil- 
lion, at its meeting in May. ■ 



From I9I3 until he died in 1965, 
Schweitzer practiced medicine in Africa, 
where "he found his emotional and spir- 
itual sustenance by playing Bach late 
into the night on a special piano 
designed to withstand the jungle humid- 
ity," Forrow adds. 

Since 1979, more than 50 fourth-year 
HMS students have spent three months 
each as fellows at Schweitzer's hospital 
in Lambarene, Gabon. More recently, 28 
HMS students have served as Boston 
Schweitzer Fellows, working in the 
city's homeless shelters, AIDS chnics, 
and other frontline agencies. 

"This event," says Forrow, "is a cele- 
bration of Schweitzer's Me and legacy, 
the important role of music in healing, 
and the continuation of Schweitzer's 
legacy through new generations of HMS 
students and alumni." ■ 

HMS Retains Its 
Conflict-of-interest Policy 

IN A MEMO TO MEMBERS OF THE FACULTY 

this May, Dean Joseph Martin announced 
that he wiU not be recommending any 
new exceptions to the School's conflict- 
of-interest pohcy. 

Martin stated, however, that HMS 
wiU be implementing a faculty commit- 
tee's recommendations for strengthening 
the safeguards to protect medical stu- 
dents, graduate students, and other 
trainees from potential conflicts created 
by their m^entors' financial interests. 

The committee, which has been 
reviev^ing the School's ten-year-old poMcy 
since 1998, found great variabihty in con- 
fhct-of-interest policies nationwide. 
"Rather than add yet another variation," 
Martin wrote, "we would like to engage in 
a national dialogue on the issue invohong 
universities, government, and industry. 

"I look forward to participating in an 
ongoing dialogue on ways we can restore 
pubhc trust in our research at the same 
time that we try to move science forward 
as efficiently as possible to the benefit of 
humankind," Martin added. ■ 



6 HARVARD MEDICAL ALUMNI BULLETIN • SUMMER 2000 




iVlUILil UUy FRIENDS AND FAMILY SHOWED UP TO SUPPORT STUDENTS IN THE 

Class of 2000 as they gathered outside the registrar's office in March to learn 
where they would be spending their residency. In June, 168 students were gradu- 
ated; of those, 157 chose to enter chnical residency programs. The other 11 are 
deferring residencies to pursue opportunities ranging from writing to research to 
consulting. Primary care was the most popular residency, with 43 percent of the 
graduating class making that choice. Almost half of the students (48 percent) 
matched at Harvard-affiliated teaching hospitals. 



ANESTHESIA 

Hovig Chitilian 

Massachusetts General Hospital 
John Hiebert 

Brigham and Women's Hospital 
Ravi Joshi 

Massachusetts General Hospital 

DERMATOLOGY 

Amy Adams 

Massachusetts General Hospital 

Ritu Batra 

Stanford IJniversity Programs 

Michelle Bonta 

Oregon Health Sciences 

University, Portland 

Alex Carcamo 

Massachusetts General Hospital 

Howard Chang 

Stanford University Programs 

Daihung Do 

Boston University Medical Center 

Kenneth Katz 

New York University Medical Center, 

New York, NY 

Karen Taraszka 

Yale-New Haven Hospital 



EMERGENCY MEDICINE 

James Eadie 

Brigham and Women's Hospital 
Shan Liu 

Brigham and Women's Hospital 
Benjamin Sun 

Brigham and Women's Hospital 

FAMILY PRACTICE 

Beverly Aist-Mejia 

CHRISTUS Santa Rosa Health Core, TX 
Melissa Dixon 
Boston Medical Center 
Nerissa Koehn 

Tacoma Family Medical, 
Tacoma, WA 
Rebecca Mammo 

University of California, San Francisco 
Raul Trejo 

Scripps Memorial Hospital, 
Chub Vista, CA 

GENERAL SURGERY 

Liliana Bordeianou 

Massachusetts General Hospital 
Glenda Callender 

University of Chicago Hospital 



Rodney Chan 

University of Washington 

Affiliated Hospitals 

Sharon Chang 

University of California Davis 

Medical Center, Sacramento, CA 

Aaron Cheng 

University of Colorado School 

of Medicine, Denver, CO 

Heather Cohen 

Stanford University Programs 

Christine Hsu 

Brigham and Women's Hospital 

Timothy Jackson 

Brigham and Women's Hospital 

Marcus Jarboe 

The University Hospital, 

Cincinnati, Ohio 

Bart Kane 

Brigham and Women's Hospital 

Cassandra Kelleher 

Washington Universit/, 

St. Louis, MO 

Shaun Kunisaki 

Massachusetts General Hospital 

Emerson Liu 

Emory University School of Medicine, 

Atlanta, GA 

Ricardo Moreno 

New York University Medical Center, 

New York, NY 

Brian Saunders 

University of Michigan Hospitals 

INTERNAL MEDICINE 

Jennifer Ang 

Brigham and Women's Hospital 

Andrew Atiemo 

Brigham and Women's Hospital 

Ingrid Bassett 

Brigham and Women's Hospital 

Laurence Beck 

Boston University Medical Center 

Stephen Boppart 

University of Illinois College 

of Medicine, Urbono, IL 

Nakela Cook 

Massachusetts General Hospital 

Cascy-Arnou Chariot 

St. Vincents Hospital, New York, NY 

Annabel Chen 

Massachusetts General Hospital 



SUMMER 2000 • HARVARD MEDICAL ALUMNI BULLETIN 



PTIT^SE 



MAKING THE ROUNDS AT HMS 




Dilon Daniel 

Baylor College of Medicine, 

Houston, TX 

Saumya Das 

Massachusetts General Hospital 

Meg Doherty 

Massachusetts General Hospital 

Jon Duke 

Brighom and Women's Hospital 

Joanne Dushay 

Beth Israel Deaconess Medical Center 

Brendan Everett 

Massachusetts General Hospital 

Rachel Greenberger-Rosovsky 

Brighom and Women's Hospital 

Naomi Hamburg 

Massachusetts General Hospital 

Yuchi Han 

Stanford University Programs 

Shannon Heitritter 

Brighom and Women's Hospital 

Eric Heller 

Johns Hopkins Hospital 

Leora Horv^itz 

Mount Sinai Hospital, New York, NY 

C. Starck Johnson 

Boston Medical Center 

Iris Kedar 

Beth Israel Deaconess Medical Center 

Kiran Khush 

University of California, 

Son Francisco 

Sarah Lapey 

Brighom and Women's Hospital 



Lucy Martin 

Johns Hopkins Hospital 
Matthew Matasar 

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Presbyterian, New York, NY 

Erica Mayer 

Brighom and Women's Hospital 

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Stephanie Nonas 

Brigham and Women's Hospital 

David Ramirez 

Cedors-Sinoi Medical Center, Los 

Angeles, CA 

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Eunice Tsai 

Stanford University Programs 
Carolyn Whatley 

New York University Medical Center 
John Wylie 

Massachusetts General Hospital 
Andrev/ Yee 

Massachusetts General Hospital 

NEUROLOGY 

Anthony Chen 

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Yun-Beom Choi 

Columbia University, New York, NY 
Amy Hansen 

University of California, Los Angeles 
Lisa Horovs^itz 

University of Washington Affiliated Hospitals 

NEUROSURGERY 

Manish Aghi 

Massachusetts General Hospital 

Rose Du 

University of California, San Francisco 

Adam Lipson 

University of Washington 

Affiliated Hospitals 

Marcus Ware 

University of California, San Francisco 

OB/GYN 

Nerissa Concepcion 

Cedars-Sinai Medical Center, 
Los Angeles, CA 



HARVARD MEDICAL ALUMNI BULLETIN • SUMMER 2000 



Carolyn Cruz 

University of California, Son Francisco 

Yashika Dooley 

Wrigfit-Patterson Air Force Base, 

Dayton, OH 

Karen Fish 

Women & Infants Hospital, Providence, Rl 

Zsakeba Henderson 

Brigfiam and Women's Hospital 

Elizabeth Johnson 

University of Wasfiington 

Affiliated Hospitals 

Lena Kim 

University of California, San Francisco 

Laura Meeks 

Brigham and Women's Hospital 

Ann Schutt-Aine 

University Health Center of Pittsburgh 

OPHTHALMOLOGY 

Fina Barouch 

Massachusetts Eye and Ear Infirmary 
Mary Saleeb 

Wills Eye Hospital, Philadelphia, PA 
Michael Tron 

University of California, Los Angeles 

ORAL SURGERY 

Ho>vard Clark 

Massachusetts General Hospital 
Jennifer Forshey 

Massachusetts General Hospital 
Melissa Lackey 

Massachusetts General Hospital 

ORTHOPEDIC SURGERY 

Mark Adickes 

Mayo Graduate School of Medicine, 

Rochester, MN 

Dre>v Brady 

University Health Center of Pittsburgh 

Jennifer Cook 

Harvard Combined Orthopedics Program 

Carl Deirmengian 

Hospital of the University of Pennsylvania, 

Philadelphia 

Jeremy Moses 

Harvard Combined Orthopedics Program 

Erik Spoyde 

Harvard Combined Orthopedics Program 

Lawrence Sullivan 

University of Michigan Hospitals 



OTOLARYNGOLOGY 

Nor Chioo 

University of California, Davis 
Jennifer Shin 

Harvard Medical School 

PATHOLOGY 

John Brando 

Massachusetts General Hospital 
Robert Padera 

Brigham and Women's Hospital 

PEDIATRICS 

Amy Adams 

Boston Combined Pediatric 

Residency 

Alexy Arauz 

Massachusetts General Hospital 

David Chond 

University Hospitals of Cleveland 

Grace Cheng 

University of Washington 

Affiliated Hospitals, Seattle 

Sarah Coots 

Children's Hospital, Oakland, CA 

Elizabeth Flynn 

Boston Combined Pediatric Residency 

Elena Huong 

The University Hospital, Cincinnati, OH 

Kotherine Janev^ay 

Boston Combined Pediatric Residency 

Eriko Kempler 

Oregon Health Sciences University, 

Portland 

Amy Kostishock 

University of California, San Francisco 

Huy Nguyen 

University of Washington Affiliated Hospitals 

Maureen O'Brien 

Boston Combined Pediatric Residency 

Laura Robertson 

New York Presbyterian Hospital 

(Columbia Campus Program), 

New York, NY 

Melissa Schorf 

Massachusetts General Hospital 

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University of Washington Affiliated Hospitals 

Maureen Su 

University of California, San Francisco 

Soro Toomey 

Boston Combined Pediatric Residency 



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5>RVARD MEDICAL ALUMNI BULLETIN • SUMMER 


2000 





PRESCRIPTIONS FOR A NEW MEDICINE | 



r^ I / I 



Whistleblowing 



HAT PROPORTION OF MEDICAL ERRORS, RESULTING 

^y^yMfM ill perhaps as many as 100,000 deaths each 
k w> VjP' year in the United States, could be prevented 
* ^ * by systematic changes to the health care sys- 
tem, and how many are the tragic, but 
inevitable, results of the fact that imperfect human beings 
practice medicine? And what is the role of a participant or 
bystander who sees harm being systematically done? 

I first became impassioned about this issue in medical school 
more than 25 years ago. As an Armenian American, I had been 
raised with stories of the Armenian massacre of 1915, in which no 
one had rescued the victims. When I witnessed injustices, 1 
spoke out. Tragically, when health care practitioners at the hos- 
pital where I then worked failed to report their incompetent and 
impaired peers, I faced a test whose outcome still troubles me. 

Three of the first four patients whose care I observed during 
a cardiac surgery rotation failed to survive, largely because of 
poor surgical technique and excessive time on the bypass pump. 
Alarmed, I began asking operating 
room technicians and nurses if this 



I have regretted that I didn't do more. And I worry about the way 
pressures not to blow the whisde protect flaws in the system or 
practitioners tacidy recognized to be a danger to patients. 

In Massachusetts, the obligation to report a pattern of med- 
ical incompetence has since been made mandatory. The law 
requires anyone aware of a health care practitioner's impairment 
to report it to the Board of Registration in Medicine. Impair- 
ment is defined as conduct that "places into question the physi- 
cian's competence to practice medicine, including but not limit- 
ed to gross misconduct in the practice of medicine or practicing 
medicine fraudulendy beyond its authorized scope or with 
gross incompetence." Physicians also must report cases in 
which a health care worker's "ability to practice is iinpaired by 
alcohol, drugs, physical disability, or mental instability." 

Impairment can take many forms, even if it does not auto- 
matically result in demonstrable harm to patients. While taking 
an orthopedic course at one of Boston's best hospitals, I 
observed exhausted residents who had been on call three nights 
out of four for 18 months. After watching residents experience 
family problems and emotional turmoil — and even throw 
instruments around the operating room — I decided against 
becoming a surgeon and went into internal medicine instead. 



was normal for this team, and they 
said that the team's high mortahty 
rate was well-known throughout the 
hospital. In fact, the team's surgical 
cases were mosdy referred from out- 
side the area, because local doctors 
knew to avoid that particular team. 

I approached the hospital's chiefs of medicine and cardiology. 
They ordered me not to discuss the matter with anyone, saying 
that it was beyond my understanding. They suggested that the 
patients had been so sick that other doctors would not operate 
on them, which would account for the high mortahty rates. 
They also imphed that if I went to the press, I would jeopardize 
my career. For several weeks, I agonized over the best course of 
action. We finally reached a compromise. The hospital chiefs 
promised to form a committee to evaluate the surgical team's 
practice. In turn, I agreed not to report the situation. 

Two years later, the Boston Globe ran a story that was brought 
to light by an operating room technician at another hospital ia 
which this team had also operated. In the two years between my 
original expression of concern and the appearance of the Globe 
story, the mortahty rate for the team's open-heart surgery 
patients had been a stunning 50 percent. When I read the article, 
I felt both betrayed and guilty. I calculated that between my ini- 
tial observation and the whisdeblowing, some 200 people had 
died needlessly The Globe story prompted hospital officials to 
form a committee, which later ascribed partial responsibility to 
the doctors. The operating room technician was fired. To this day, 



I felt both betrayed and guilty. I calculated that 
between my initial observation and the whistle- 
blowing, some 200 people had died needlessly. 



I never accepted the idea that we were somehow better off if 
we learned how to work 36 hours in a row. As far as I could tell, 
sleep impairment only left us hostile toward our patients and 
the medical system. Studies have shown, in fact, that 24 hours 
of wakefulness impairs cognitive performance equivalent to a 
blood alcohol level of 0.1 percent. And one recent study in The 
Lancet found that surgeons who perform virtual operations 
after 24 hours without sleep demonstrate a 20 percent increase 
in errors compared with their error rate when well rested. 

I beheve that anyone who has worked for 24 hours straight is 
impaired and should not be practicing medicine. I also beUeve 
that any hospital that supports 24 hours on call without proper 
sleep is violating the law and endangering patients. To encour- 
age the reporting of medical incompetence, perhaps hospitals 
should consider a reward system similar to the federal whisde- 
blower laws. Until honoring such mandates becomes routine 
practice in all hospitals, some physicians wiU continue to put 
their patients' Hves — if not their own consciences — at risk. ■ 

Thomas hlajarian 74 is medical director of Medical Online, Inc. in 
Lexington, Massachusetts. 



SUMMER 2000 • HARVARD MEDICAL ALUMNI BULLETIN 



11 



ROOKMAHK 



REVIEWING THE PRINTED WORD 



Doctors Afield 



•'"^ 



Edited by Mary G. McCrea Curnen, Howard Spiro '47, 
and Deborah St. James (Yak University Press, 1999) 

THE REPORT FOR OUR TENTH REUNION WAS THICK A>JD FACTUAL, 

though all the organization in the world could not control the 
chaos and color of 165 scattered medical hves. 

Once we had been equally unformed — shipmates rowing 
vigorously in the same unknown direction. Back then, in the 
leaky prow of Amphitheater D, few of us had any idea where we 
would wash up on shore. A decade later, we had landed in vast- 
ly different places. The GI surgeon in Utah had eight children 
now. Before he had become a surgeon, he was the calm student 
who always sat in the middle of the row; very 
pale, very unruffled, very poHte. The sleep 
specialist in Boston, before he had become a 
sleep speciahst, used to wander into lectures 
halfway through the morning, looking 
refreshed and unapologetic. The emergency 
room physician in Ohio skied before finals 
and juggled on the Quad. The Baltimore psy- ; 
chiatrist used to .sit with his knees crossed in 
anatomy, his hands folded; he never took notes, 
but Mstened with freely hovering attention. 

Everyone was somewhere else now, ten 
years advanced, defined, constructive, med- 
ical, arrived. What we had left in common, 
according to the reunion report, was the sense 
of the endlessness of each long professional day 
and, at the same time, the rapidity of each flying year. 

But we had something else in common, too. Most everyone 
was more than a doctor now: there was a hiker, an aviator, a 
Lionel toy train collector, a firefighter, a woodworker, a church 
nursery director, a house-builder, a Jujitsu master. "Good God," 
said my lawyer-husband, "dorit they do enough already?" 

It's nothing new. Saint Luke was a physician, as was the 
philosopher John Locke. David Livingstone was a doctor and 
so was Thomas Dover, a pirate who studied at Cambridge and 
used his high-sea booty to fund a medical practice in London. 
You can learn this in the preface to Doctors Afield, a collection of 
essays by physicians who are all more than doctors. The book 
is a series of voices trying to explain their multiphcities. 

Where to begin? There is the transplant surgeon who paints 
his patients' portraits, then gives photocopies to the pediatric 
patients so they can color them in together. There is the ortho- 
pedist sculptor (which seems to follow smoothly enough) and 
^ the urologist who, as a special assistant to the secretary of 
I transportation, helped plan security for the 1996 Atlanta 
S Olympics (less logical a flow). There is Ernest Craige '43A, car- 

diologist and cartoonist; in World War II, he created this nifty 

1 anti-VD slogan for the soldiers abroad: 'Just 'Cause She's 





Demure, Dorit Mean She's Pure." There is the wane-making 
psychoanalyst, the cabaret-singer endocrinologist, the pianist 
gastroenterologist, and Ray Hammond '75, who, at age 41, left 
surgery and emergency medicine to found an African 
Methodist Episcopal church with his wife in inner-city Boston. 
In other words, there are cardiologists, pediatricians, sur- 
geons, psychiatrists, anesthesiologists, and internists who are 
also sculptors, photographers, musicians, ministers, poets, and 
pohticians. There is an astronaut and a legislator, a priest and 
a cartographer. There is a novehst, a composer, and the inven- 
tor of the Erector set. Their descriptions of themselves are 
proud, formal, shghtly abashed, somewhat surprised, occa- 
sionally severe. Some of the writers are unable to escape dense 
medical syntax, some fly freely into imprecise 
adjectives; all are passionate. Everyone, need- 
less to say, is also tired. 

There are also eloquent explanations of 
how nontraditional Hves give respite from 
traditional medicine, and why this is so nec- 
essary. Boston pediatric trauma specialist 
and jazz tuba player Eh Newburger writes 
that "every improvisation carries with it a 
prospect of redemption...'mistakes' in jazz... 
become platforms for new ideas, not catastro- 
'°^ phes that destroy hves." In an essay lovely with 

metaphor, writer Rafael Campo '90 describes 
how poetry "can teach an alternate anatomy of 
the heart." An academic internist who also col- 
lects rare coins writes simply, "the profession [of 
medicine] controls me rather than vice versa." 

Medicine is enough, more than enough, sacred, and often 
too much — and yet, it is also not enough. This business is 
immense — a black hole of efforts and hours. It can be redemp- 
tive. But it is not always restorative, not in a hteral self-ish way. 
We become parents. We become church members. Some 
of us read murder stories. Some write them. Some sing in 
choirs, or make art, or make cookies, or make it a point to 
take walks — around the block, or in space. We do what we 
can with what little energy we have at the end of the 
stethoscope or consulting chair and at the end of the day. 
To treat ourselves, we must be more than doctors. The pho- 
tographer Walker Evans understood why. "Stare," he once 
wrote. "Pry, Hsten, eavesdrop. Die knowing something. You 
are not here long." 

In the Tenth Reunion Report, one alumna wrote in brief syl- 
lables of her occupations: research, children, gardening, cook- 
ing. Then, in the comment section, she added four words 
(probably because she had no time to write more): "Since 
1987 — I'm happy." ■ 



Elissa Ely '88 is a lecturer on psychiatry at EMS. Although she graduated 
in 1988, she matriculated with the Class of 1987. 



12 



HARVARD MEDICAL ALUMNI BULLETIN • SUMMER 2000 



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Death Foretold 

Prophecy and Prognosis in Medical Care, 
by Nicholas A. Christakis '88 
(University of Chicago Press, 2000) 

Prognosis, diagnosis, and dierapy are the 
cornerstones of medical practice, but 
prognosis has traditionally garnered the 
least attention. Christakis argues that 
prognosis casts physicians in the position 
of prophets, and he explores the power 
and responsibility of such a role. Based on 
interviews with physicians, audiotaped 
clinical encounters, and a thorough review 
of the literature, Christakis examines doc- 
tors' moral duty to predict patients' 
futures and appropriate ways of doing so. 

Timeline 

by Michael Crichton '69 
(Alfred A. Knopf, 1999) 



In his I2th novel, Crichton reverses the 
process by which he brought the prehis- 
toric world into the twentieth century in 
Jurassic Park. Here, he sends a team of young 
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themselves immersed in the Hundred 
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mentor. The novel offers readers a unique 
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Conscience is Good Medicine 

by Robert B. Giles, Jr. '49 (Eakin Press, 2000) 

Giles offers a personal recollection of Mv- 
ing through a golden era of medicine. The 



author and his father were practicing 
physicians in Texas for a combined total 
of 70 years. He describes the astoimding 
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ethics and morals over time. 



30 Secrets of the World's 
Healthiest Cuisines 

Global Eating Tips and Recipes from China, 
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The authors combine some of the latest 
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Effective Management of 
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A Practical Guide (2nd Edition), by Royce 
Moser, Jr. '61 (OEM Health Information, 1999) 



Filled with practical strategies and 
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Intimate Strangers 

Unseen Life on Earth, by Cynthia Needham, 
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(American Society for Microbiology, 2000) 



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Pocket Medicine 

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Handbook of Internal Medicine, 
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Designed to provide key cHnical informa- 
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medical students and interns carry, this 
guide summarizes the most important 
points about the common problems seen 
in each of the basic areas of internal med- 
icine. The six-ring binder, which contains 
blank space for a student's own notes 
and accommodates additional pages, was 
prepared by residents and attendings at 
Massachusetts General Hospital. 



SUMMER 2000 • HARVARD MEDICAL ALUMNI BULLETIN 



13 



RKNCHMAHKS 



I DISCOVERY AT HMS 



Getting a Heads Up on Migraines 




OST OF US ARE OBLIVIOUS TO THE 

physical happenings inside 
our heads — the pulsing of 
blood, the fluttering of the 
dura (the membrane that surrounds the 
brain), the rise in intracranial pressure 
that follows a cough or sudden head 
movement. During a migraine, such 
goings-on can create inner pandemoni- 
um. On top of the constant throbbing 
that is a hallmark of migraines, simple 
gestures — a tilt or a shake of the head — 
can result in excruciating jabs of pain. 
Even at rest, a person vi^ith a migraine 
feels things most people do not. 



"Migraine patients wdll teU you they 
are aware of the space between their 
brain and skuU," says Rami Burstein, 
associate professor of anesthesiology at 
Beth Israel Deaconess Medical Center. It 
now appears that this almost preternat- 
ural sensitivity is not limited to the con- 
fines of the skuU. Burstein, who is also 
HMS associate professor of neurobiology, 
and his colleagues have found that, dur- 
ing a migraine, patients may experience a 
range of painful hypersensitivities — 
symptoms that have only rarely been dis- 
cussed with doctors and had not been 
noted in the medical hterature until now. 




In an experiment reported in the May 
Annals ofNcurology, the researchers stud- 
ied 44 patients before and during a 
migraine. They found that, during an 
attack, normally nonpainful sensations, 
such as a delicate brush or shght heat- 
ing or cooling of the skin around the 
eyes, produced almost unbearable pain 
in 79 percent of patients. So sensitive 
was their skin that pressure equivalent 
to the nudge of a single strand of hair 
was said to feel like the thrust of a nee- 
dle. Nor was this hypersensitivity limit- 
ed to the skin of the face. Forty percent 
of patients displayed extreme sensitivi- 
ty in the skin of the arm, another area 
tested in the study. 

On the one hand, the study alerts 
patients and doctors to a set of symp- 
toms that is often ignored. But the 
research also points to a newly hatched 
understanding of migraines — and pos- 
sible therapies. 

A Chain Reaction 



EXTREME SENSITIVITY: Rami Burstein found that most migraine patients perceive 
even a light brushing around the eye as painful. 



Burstein believes that during a 
migraine, a chain of neuronal clusters 
becomes progressively "sensitized" in 
such a way that each cluster responds 
to stimuli that it would otherwise 
ignore, such as the pulsing of blood or 
changes in intracranial pressure. While 
the first cluster receives signals only 
from within the skull, specifically the 
dura and blood vessels, the others are 
more promiscuous. For example, the 
second cluster also receives input from 
the face, and the third from other areas 
of the body. Once sensitized, they per- 
ceive as painful otherwise nonpainful 
stimuli from those extracranial regions. 
The progressive sensitization of the 
first, second, and third clusters could 
account, respectively, for the throbbing 
and facial and body pain, but Burstein 
believes it may explain other symptoms 
that migraine patients experience. Loss 
of appetite and sleep and mood 
changes, which are often viewed as side 
effects of the pain, may actually be 
caused by activation of higher-order 
neurons in the brain. 



14 



HARVARD MEDICAL ALUMNI BULLETIN • SUMMER 2000 



WHAT HAPPENS DURING A MIGRAINE 



Neuronal clusters (green) become progressively 
sensitized, responding to stimuli that they would 
otherwise ignore. The progressive sensitization of 
the first, second, and third clusters could account, 
respectively, for the throbbing and facial and body 
pain that migraine patients experience. 



(3) thalamus 



Release of inflammatory 
agents initiates the pain 



(2) nucleus 
caudalis 




trigeminal 
anglion 



Sensitized neurons 
Normal neurons 



Most migraine drugs target the first 
cluster of neurons, the trigeminal gangHon, 
essentially putting it to sleep. But such a 
strategy may not work for migraine suffer- 
ers who experience skin pain. Working 
with rats, Burstein has found that if the 
second cluster, the nucleus caudalis, is 
allowed to remain sensitized for an hour or 
more, it wiU maintain its sensitivity — and 
presumably continue to cause pain — even 
when the first cluster is put to sleep. 

"This could explain why current 
antimigraine therapies, which work on 



the primary cluster, are only effective if 
taken during the first hour after an 
attack has begun," Burstein says. "So 
this study says to drug companies, 
'Hey, you missed the most important 
part of the antimigraine drug indus- 
try — you have to target the secondary 
neurons."' 

Getting a Grip 

For years, migraines were thought to be 
caused by the overexpansion of blood 



vessels in the head, which resulted in a 
buildup of mechanical pressure. In the 
early 1990s, HMS Professor of Neurology 
Michael Moskowitz and others showed 
that inflammatory substances released 
by blood vessels and nerve endings were 
overactivating the trigeminal ganglion, 
located just above the palate. 

Four years ago, Burstein, working 
with Andrew Strassman, HMS assis- 
tant professor of anesthesia, showed 
that when inflammatory proteins were 
released around the dura and blood ves- 
sels of rats, neurons in the trigeminal 
ganglion were not only activated, but 
also sensitized. Knowing that these 
neurons sent signals to a cluster of neu- 
rons in the spinal cord, which also 
receives input from the skin around the 
eye, he tested cells in the nucleus cau- 
dalis to see if they would respond to 
normally imperceptible mechanical 
stimuli from the dura and skin. Sure 
enough, they did. And their responses 
were accompanied by a rise in heart rate 
and blood pressure, suggesting that the 
rats were feeling pain. 

Burstein and his colleagues suspect- 
ed that the migraine patients might 
also feel pain when stimulated around 
the eye. But they had no idea that such 
sensitivity might extend to other parts 
of the body, which were included in 
the experiment as control areas. "That 
was the most surprising thing to us," 
he says. 

It might also seem astonishing that 
such hypersensitivity has been so sel- 
dom discussed by patients. When 
Burstein questioned subjects in his 
study, they told him that they were 
wary of being labeled crazy or hysteri- 
cal. "Migraine is a very unclear disease," 
he says. "It mostly affects women, and 
there's a social implication to that — 
that they're not really sick." 

Burstein encourages patients to over- 
come their fears and tell their doctors. 
"Don't be afraid to tell your clinician the 
weirdest symptoms you have," he says. 
"It could help in the diagnosis." ■ 

Misia Landau is senior scicnccwritcrforFocus. 



SUMMER 2000 • HARVARD MEDICAL ALUMNI BULLETIN 



15 



t 



PHYSICIAN, 




For physicians struggling to cope with the current stresses 
in medicine, the search for a cure begins within 



"I FEEL A SENSE OF ISOLATION WITHIN MY OWN 

hospital," a 40'year'old general internist and 
mother of twins confessed to me recently. "The 
current push for productivity has packed my 
schedule to the point that I regularly skip grand 
rounds, which I used to enjoy, grab a quick 
lunch — on my good days — and try to go home at 
a reasonable hour to be with my family. The 
economic message we're being given is very clear. 



by Charles J. Hatem 



16 



HARVARD MEDICAL ALUMNI BULLETIN • SUMMER 2000 




00 often we fall into the sad irony of caring for 



and at the same time, we're being asked 
to teach students and house staff — and 
get ourseh'es promoted. I'm not sure 
how long I want to be on this treadmill!" 
This internist's lament is not unique. 
In this time of increasing pressures on 
doctors, the spectrum of physician dis- 
tress ranges from this sort of disaffec- 
tion to the painful reality of profession- 
al and personal disability. We need to 
tackle these issues head on, not only for 
our own sake, but for the good of those 
close to us and, ultimately, for our 
patients' well-being. 

The Balancing Act 

Professional hypocrisy — dispensing to 
others yet personally ignoring advice 
about leading a balanced life — is not a 
new problem for medical practitioners. 
Too often we fall into the sad irony of car- 
ing for patients while neglecting our- 
selves and those close to us. Moreover, 
our training as autonomous decision- 
makers frequently translates into our 
denying our own need for help. Beyond 
these well-known stresses are the ones 
the current Kterature bemoans; the cor- 
ruption of medicine's values and the con- 
sequent disenchantment of many physi- 
cians. The research portrays a disturbing 
epidemiology of disaffection, burnout, 
and v/ithdrawal from medicine. 

Yet we need not succumb to these 
troubles. To preserve ourselves and our 
profession, we must recognize the need 
to renew ourselves, to reaffirm medi- 
cine's fundamental values, and to 
remember the privileges associated with 
the care of patients. John- Henry Pfiffer- 
ling, a medical anthropologist whose 
work focuses on quaffty-of-Me issues for 
physicians, has described observations 
from more than 1,200 doctors who have 
not only experienced loss in their per- 
sonal hves and in their work, but who 
have also misplaced their sense of joy 
and satisfaction. These physicians 
offered a list of lessons they vvashed they 



had learned at earher points in their 
careers, such as how to find balance in 
their Hves and how to say "No!" in the 
face of ever-increasing demands. Their 
losses serve as pointed reminders that 
we are aU at risk, and that we cannot 
afford to run on autopilot. 

But where does renewal begin? The 
answer is deceptively simple: it begins 
with ourselves, and the realization that 
we are not limitless resources. Framed 
by the current disquiet in medicine, 
author John Gardner's reflections on 
self-renewal offer us a pointed chaUenge; 
"Just as shared beHefs and values are sus- 
ceptible to decay, so are they capable of 
regeneration. Humans are not without 
talent in the creation and renewal of 
value systems. It may be their most dis- 
tinctive activity. But in a world of svdft 
change it calls for unrelenting effort." 

The reconnection to our famOies, sig- 
rdficant others, and friends can serve as a 
powerful beginning point. When I was 
making rounds recentiy, a conversation 
with an off-duty colleague moved me. 
He had stopped by the hospital to say 
hello to a feUow doctor who was on call, 
a xisit meant to celebrate their friend- 
ship, which had begun 30 years earffer 
to the day. Clearly in the challenging 
aspects of their common work, this rela- 
tionship had been sustaining. How many 
friendships do we celebrate? 

We are not strangers to the strate- 
gies of renewal. Our counsel to others is 
straightforward enough: regular health 
care and exercise (not just lugging an 
unopened briefcase stuffed with unfin- 
ished work from office to home to 
office); adequate rest and guilt-free 
vacations unencumbered by unread 
journals; time alone to reflect and med- 
itate; and the pursuit of interests 
beyond medicine. We know that satis- 
faction — and survival — in medicine 
requires both a clear demarcation of 
boundaries and a sense of humor. 

In addition, the appreciation of the 
role of humanities in medicine is grow- 



ing, with an expanding resource of 
extraordinary literature available for 
our enlightermient. There also is an 
increasing affirmation of the spiritual 
dimension of medical practice. This 
spirituality is not necessarily reffgious, 
but it can connect us with the tran- 
scendent principles that inform the 
care of patients and reflect the core val- 
ues of medicine. 

Following the Sigmoid Curve 

A useful template for physician renewal 
hes in the "sigmoid curve," the ancient, 
sinuous curve so descriptive of biologic 
and social processes alike. The sigmoid 
curve teaches us to challenge ourselves 
at "point A" — our point of ascendancy 
or mastery — rather than at "point B," 
our point of dechne. This model caffs 
for us to change ourselves whffe we 
stffl have the considerable energy and 
resources we need to pursue a new 
vision. Our ffves, in fact, should ideaUy 
foUow a succession of such curves, not 
as escape trajectories, but as paths of 
renewal: the hobbies to be started or 
resurrected, the pursuit of new inteUec- 
tual and social initiatives, the redefini- 
tion of time with family and friends. 

Perhaps most critical of aU for renewal 
is our own mindset. In Viktor Frankl's 
Man's Search for Meaning, the renowned 
Viennese psychiatrist writes about 
choosing to stay with his Austrian family 
in the dark days of World War II despite 
a visa to flee to the United States. Among 
his family members, only he sur\ived the 
camps, making his assertion aU the more 
poignant. "Anything can be taken from a 
man," he wrote, "but one thing: the last of 
human freedoms — to choose one's atti- 
tude in any given set of circumstances, to 
choose one's own way." 

How simple the notion: attitude is 
key. Betsy Sanders, author of an inspira- 
tional book on the power of ordinary 
acts, teUs the story of a bag lady who 
entered a major department store at the 



HARVARD MEDICAL ALUMNI BULLETIN • SUMMER 2000 



patients while neglecting ourselves and those close to us. 



height of the hohday season. She caught 
the attention of a local minister, who fol- 
lowed her, thinking that she could ease 
the bag lady's distress when the 
inevitable ushering out occurred. But 
instead, when the bag lady made her 
way to the fine-dress department, she 
was assisted in trying on various 
dresses. When the saleswoman was 
asked about this incident, she said she 
beheved that her job was "to serve and 
be kind," an extraordinary attitude that 
we should all be proud to call our own. 

Lessons in Healing 



Our attitudes must be calibrated to the 
values that are central to our hves. This is 
no small matter. In the view of 
Jewish theologian Abraham Hes- [T^ 
chel, "To heal a person, one must 
first be a person." We need to 
understand clearly what it is that 
brings us happiness in caring for 
our patients. 

The values that ideally guide 
our hves and our work were 
wonderfully articulated by 
physician Ralph Crawshaw and 
coauthors in the Journal of the 
American Medical Association. 
"Medicine is, at its center, a 
moral enterprise grounded in a 
covenant of trust," the authors 
wrote. "By its traditions and 
very nature, medicine is a special kind of 
human acti\'ity — one that cannot be pur- 
sued effectively without the virtues of 
humihty, honesty, intellectual integrity, 
compassion and effacement of excessive 
self-interest. These ttaits mark physi- 
cians as members of a moral community 
dedicated to something other than its 
own self-interest." 

Daily, we are allowed access to the inti- 
mate stories embedded in our patients' 
hfe-and-death issues. Emotional fatigue 
often becomes the distorting prism that 
prevents a clearer understanding of the 
privileges of doctoring, but the lessons are 



there, ready for our reflection. I think of 
my patient "Gina," whose college gradua- 
tion was thwarted by her promyelocytic 
leukemia. She decided that, rather than 
have her long, lovely hair yield to 
chemotherapy, she would take control 
and cut it off herself. Her sense of equa- 
nimity during her suffering marked her 
role not as student, but as teacher. 

And I think of how "BiU," whose 
youth was spent in poverty, helped me 
understand the struggles of many dur- 
ing the Depression. His perseverance 
and subsequent career success were tes- 
taments to his strength and comactions 
as he confronted major debffitating ill- 
nesses while caring for his wffe, who 
suffered from progressive dementia. 



THE SIGMOID CURVE 




The sigmoid curve teaches us to challenge our- 
selves at "point A" — our point of ascendancy — 
rather than at "point B," our point of decline. 

FIGURE COURTESY OF CHARLES HANDY, THE AGE OF PARADOX. RECREATED 
WITH PERMISSION, HARVARD BUSINESS SCHOOL PRESS, ©1994. 



There are scores of other examples in my 
practice and in yours. 

We need only to see. We need only to 
remind ourselves of what it is that gives 
our work meaning and joy. Whatever the 
admixture of our work — research, 
patient care, teaching — ^we can find plea- 
sure in refining our professional skills, in 
adapting new advancements to our daily 
practice, and in sharing our lessons with 
the next generation of physicians. 

One role model for me in achieving 
such feats was Leo Blacklow 30, who 
practiced in our community for more 
than 50 years. Until his death six years 



ago, he was a \'ibrant, intellectually ahve, 
and curious physician; his passion for 
medicine was palpable. He often said 
that he received sustenance from three 
famihes — his biological family, the family 
of his patients, and the family of his col- 
leagues. We, too, would do well to draw 
on the strengths of those around us. 

The Future Begins Now 

Peter Drucker, the legendary scholar of 
management, suggests that to prepare 
for the second haff of one's life, it is nec- 
essary to begin long before it arrives. 
That, in his words, to "manage oneseff" 
requires taking stock of personal 
strengths, reafffrming responsibihty for 
relationships, and actively plan- 
ning for the development of 
parallel career interests. 

These arguments are not new. 
Retirement is a relative term, but 
whatever it represents, we need 
to plan for it. We need to help 
patients — and ourselves — be 
proactive about this stage of hfe. 
Our values in medicine are 
too vital to become a casualty of 
the present distortions in the 
health care system. We wffl 
- always need to accommodate 

the challenge of discovery, 
understand the attendant ethi- 
cal and moral issues, and accept 
the challenge of appropriate incorpora- 
tion of the new into the care of our 
patients. But we must uphold our core 
professional values, and we cannot 
accomphsh this without preserving our- 
selves as practitioners and as people. ■ 



Charles]. Hatcm '66 is director of medical edu- 
cation at Mount Auburn Hospital in Cam- 
bridge, Massachusetts. He is also president of 
the Harvard Medical Alumni Association for 
the 2000-2001 academic year 

Passage from Crawshaw R., et al., "Patient-Physician 
Covenant," JAMA, 1995;273:1553, reprinted witti 
permission, ©1995, American Medical Association. 



SUMMER 2000 • HARVARD MEDICAL ALUMNI BULLETIN 



19 



'^•Wt^ 



by James J. O'Connell 



ALISON'S DEATH ON BOSTON COMMON THIS APRIL 

nearly broke our spirits. As her primary care 
doctor through many turbulent years, I had 
become fond of this proud, exacting, and 
often insolent BS-year-old woman. 

With a pert smile and imperial stubborn- 
ness, Alison had departed New England 
Medical Center's emergency department as 
soon as the x-rays had failed to find frac- 
tures beneath her bruised and swollen face 
on the afternoon before her death. A week 
earlier, she had histrionically hailed Pine 
Street Inris Outreach Van from her park 
bench around midnight. Bristling through 
shakes and tremors, she demanded a bed 
and posthaste delivery to her favorite detox 
on Boston's Long Island. 

I knew to brace myself in the wake of any 
formal salutation. "Doctor O'ConneU, you're 
in charge of the detox and I'm sick," she said. 
"Call now and arrange a bed. Be sure that 
Janet is the nurse on duty tonight. I had a 
drink about 15 minutes ago, and I'U need Lib- 
rium in less than an hour." 

This captivating and infuriating entitle- 
ment — urine-stained jeans and muddied 
sweatshirt notwithstanding — belied a 
fraying dignity and spiraling despair. 
Despite the late hour, the nurses were 
happy to make a bed available, and Alison's 
irrepressible charm lightened the ride 
down the expressway. We could not help 
but succumb to her laughter and heavily 





NDIML 

How does a doctor with one of the most depleting jobs- 



20 






J^OME 



providing health care to the homeless — sustain himself? 



REACHING OUT: 
Physician James 
O'Connell and his 
team from the 
Boston Health Care 
for the Homeless 
Program scour the 
dov\rnto>vn areas 
during the day, and 
ride the Pine Street 
Inn's Outreach Von 
several nights each 
week. In addition 
to medical expertise, 
they provide food, 
blankets, clothing, 
and familiar faces. 



■ 



I 




cloaked gratitude. All compliments 
were barbed. 

"Why the hell do you work on the 
van, Doc? You should be home sleeping. 
I need you to be awake tomorrow so 
that you can figure out why Fm having 
these pains in my stomach! But no 
mind, Denny will figure it out faster 
than you anyway." 

Denise Petrella is the nurse practi- 
tioner who has been my inspiration and 
partner in caring for the street popula- 
tion for many years. I had no doubt she 
would make the right — and timely — 
diagnosis. Our street team at the Boston 
Health Care for the Homeless Program 
(BHCHP) also includes two nurses sent 
directly from heaven, Cheryl Kane and 
Sharon Morrison. The challenge has 
been to step beyond acute episodic care 
on the streets and evolve a service model 
that emphasizes continuity and consis- 
tency in the dehvery of primary and pre- 
ventive care to street people whose con- 
tact with the health care system is 
marked by frequent emergency room 
visits and acute care hospitalizations. 

We join the street outreach teams 
from the Pine Street Inn, the Lemuel 
Shattuck Shelter, and the Tri-City 
Mental Health Center in scouring the 
downtown areas during the days, and 
we ride on the Pine Street Inris 0-Van 
several nights each week. Such time- 
intensive outreach, anathema in this 
modern medical era, fosters the devel- 
opment of personal relationships with 
fiercely independent people who 
assiduously avoid mainstream clinics 
and other services. Such time and 
patience are the sine qua non of effective 
street care. The 0-Van is deliberately 
designed not as a medical van, but as a 
lifeline to the streets, bringing soup, 
sandwiches, blankets, clothing, and 
familiar faces each night of the week 
from 9;00 p.m. until 5;00 a.m. 

Much of my time on Mondays and 
Wednesdays is spent serving food, 
sharing soup, and seizing every excuse 



to strike up conversations. A white coat 
or a stethoscope would scatter most of 
our street folks, but quiet consistency 
and a blessed obscurity have earned us 
trust and confidence over the past 
decade. Most on the streets know us by 
name, and no advertising is needed; the 
word is out that the doctor and nurses 
are on the van if you need help. Not sur- 
prisingly, people are proud to have a 
primary care provider and are often 
willing to come to our clinics at Boston 
Medical Center (BMC) and Massachu- 
setts General Hospital (MGH) to see 
us. We leave our beepers on, make our- 
selves readily accessible at the hospitals 
and in the shelters, offer a famihar face 
during frightening inpatient admis- 
sions, and join in the care during admis- 
sions to Mclnnis or Snead Houses, our 
two respite care facihties. 

The Long Vigil 

A year earlier, Denny and I had spent 
many hours at MGH with Alison dur- 
ing her week-long vigU prior to the 
death of her "street husband," Wayne. 
A grand mal seizure, while he was 
sleeping next to Alison on a frigid Jan- 
uary night, had progressed to status 
epUepticus by the time he arrived in 
the MGH emergency department. 
During ten days in the ICU, he never 
regained consciousness and Alison 
rarely left his side. 

"I'm pissed at him, leaving me alone 
like this." 

The exquisitely tender care afford- 
ed both Alison and Wayne by the ICU 
staff was extraordinary. Two rough- 
hewn, feisty, independent lovers who 
eschewed confinement and called the 
Boston Common home were treated 
with the utmost dignity and respect 
amid the cacophony of monitors and 
pumps and ventilators. As health care 
proxy and the only next-of-kin, Ali- 
son was attentive and sober through 
several meetings with the Optimum 



Care Committee and ultimately made 
the courageous decision to withdraw 
life supports. 

As she had promised during the ride 
to Long Island, Alison completed five 
days of medical detoxification from 
alcohol, but, to our disappointment, 
decided to forgo the 28-day program 
that had been so helpful to her in the 
past. She left for the streets two days 
before her death. 

We arerit sure how she sustained the 
facial trauma that led to her emergency 
room visit, but afterward she met an old 
friend and slept under her usual tree on 
the Common. She mentioned that she 
was tired and wanted to join Wayne. 
The O-Van staff saw her sleeping com- 
fortably under blankets around 3:00 
a.m. She never awakened. At her out- 
door memorial service, Affsoris brother 
shared tender memories framed by fam- 
ily pictures of a bright and mischievous 
toddler and a proud and strikingly 
beautiful high school graduate. Ahsoris 
ashes were placed in Wayne's grave. 

On the Margins 

Ahson was typical of Boston's "rough 
sleepers." Long a special focus of my 
practice, this group of idiosyncratic, 
rugged nomads and urban prophets 
shun emergency shelters and Hve on the 
margins of modern society. During the 
cold winter months in Boston, about 
200 people sleep in the alleys and parks, 
over subway grates, beside heating 
ducts, in doorways, and under bridges. 
During the warmer months, this number 
swells to about 600. They survive by col- 
lecting cans, panhandling (called "stem- 
ming" by the street folks), dumpster div- 
ing, working the open-air farmer's mar- 
ket at Fanueil Hall, selling the Globe and 
the Herald, and taking day labor jobs. 

Little is known about this elusive 
street population. They do not appear 
to differ demographically or ethnically 
from the sheltered homeless of Boston. 



(2 



HARVARD MEDICAL ALUMNI BULLETIN • SUMMER 2000 



who are living in abject poverty on the margins of our society? 



I 



Neither substance abuse nor chronic 
mental ilhiess is more prevalent among 
the street dwellers. Their reasons for 
avoiding shelters are legion: the shelters 
have too many people or too many rules; 
the rough sleepers have paranoid delu- 
sions, obsessive compulsion, substance 
abuse, or erratic behavior that results 
in expulsion. Most shelters in Boston 
require admission before 8:00 p.m., and 
leaving the shelter after that time means 
losing the bed for the night. For active 
drinkers, this poses an overwhelming 
dilemma. While "bootleggers" with 
cheap wine and whiskey prey outside 
most shelters at 5:30 a.m., people still 
have to be willing to withstand the long 
night with plunging blood levels of alco- 
hol and drugs. 

During one recent winter, 13 home- 
less people died on the streets of Boston. 
These deaths, which took place during a 
mild winter and at a time of unprece- 
dented economic growth, jarred our 
complacency and — at what had been a 
nadir in local and national interest 
in homelessness — suddenly generated 
intense media scrutiny. The City of 
Boston and the Massachusetts Depart- 
ment of Pubhc Health asked BHCHP to 
investigate the circumstances surround- 
ing these tragic deaths. 

While one woman remained uniden- 
tified in the city morgue, we reviewed 
the death certificates and hospital 
records of the other ten men and two 
women. The symbohsm of the institu- 
tions where their bodies were found 
was poignant, if not downright eerie: 
behind the Boston Police Headquarters 
in Roxbury, on the grates beside the 
Boston Public Library, across the street 
from the Holy Cross Cathedral, and 
even in a small park just steps from the 
main entrance to MGH. 

These people had not fallen through 
the safety net. Most struggled with per- 
mutations of severe and chronic med- 
ical, mental health, and substance abuse 
problems. All had at least four major 




medical problems, all suffered from 
acute and chronic alcohohsm, and two- 
thirds had a major mental iUness, vvath 
schizophrenia and bipolar iUness the 
most common. All had medical insur- 
ance through Medicaid, Medicare, or 
both. Strikingly, nine of the twelve had 
made emergency rooms visits to BMC 
or MGH or had been admitted as inpa- 
tients within three weeks of the day of 
death. Many had been seen multiple 
times, with several having received care 
within 72 hours of death. Ten of the 



QUIET CONSISTENCY: James 
O'Connell says that caring 
for the homeless allows him 
to rely on the skills of compas- 
sion that first attracted him 
to medicine: listening to stories, 
being available for other people, 
sharing in sorro>vs and joys, 
easing suffering, and making 
an occasional difference. 



SUMMER 2000 • HARVARD MEDICAL ALUMNI BULLETIN 



23 



twelve had entered publicly funded 
detoxification programs within six 
weeks of death, and three had died on 
the streets within a week of discharge. 
Half of those who died had also been 
admitted to Mclnnis House with acute 
medical problems during the six 
months before their deaths. 

Most of the deaths occurred on Sun- 
days or early Monday mornings, a curi- 
ous consequence of the commonwealths 
"Blue Laws," which prohibit the sale of 
alcohol on Sundays. Most had a history 
of frostbite, a recognized marker for 
those at greatest risk on the streets. And 
most imbibed Listerine, the ubiquitous 
mouthwash that contains 27 percent 
alcohol — 54 proof! — and is consumed 
by those unable to obtain wine or spirits. 

To turn the usual practice of medicine 
even more topsy-turvy, all decedents 
seen in our emergency rooms had voiced 
suicidal thoughts and plans when inebri- 
ated. Indeed, most had had high alcohol 
levels on presentation, but were found to 
be in no danger of harm to themselves 
upon psychiatric evaluation while sober 
many hours later. One 49-year-old Viet- 
nam veteran had visited the MGH emer- 
gency room more than a dozen times, all 
in the hours after midnight. The MGH 
staff often found him pounding cease- 
lessly on the hospital lobby windows, 
with a core body temperature of 92 
degrees and astonishingly high alcohol 
levels. His entreaties were faithfully 
recorded: "Fm sad"; "I'm my own worst 
enemy and I can't guarantee my safety"; "I 
could electrocute myself, because I work 
with high voltage." 

By the morning, after he had slept, 
eaten, and regained his unquenchable 
thirst for alcohol, both he and his psy- 
chiatrist were convinced that he was 
not truly suicidal and was therefore 
safe enough to return to the streets. He 
tried several detoxes, and we even went 
to court to have him committed to the 
Massachusetts Correctional Institu- 
tion at Bridgewater for 28 days of dry- 
ing out. He was back in the emergency 
room three days after his release, with a 
high alcohol level and clutching a bottle 
of Listerine. Six days before he was 




bludgeoned to death on Long Wharf, 
he came for the last time to the emer- 
gency room and literally pleaded to be 
placed in four-point restraints. 

"I can't be allowed to change my 
mind," he said. "I know I'm going to die 
if I keep this up. I know how to make a 
hangman's noose, so please don't let me 
out of these restraints when I wake up 
in the morning!" 

In the morning, after being deemed 
not suicidal, he had been sent to a local 
detoxification program. We are not sure 
whether he ever made it there. As I 
think about my patients on the streets, 
I wonder whether their hopelessness is 
a death spiral as true as the hangman's 
noose, and whether their desperate 
comments while intoxicated are the cri 
dc cocur that should be guiding our 
treatment, rather than the inevitable 
denial of the next morning. 



Blessings that Sustain 

The devastation from Alison's death 
permeated our street team for weeks, 
and the reverberations linger still. 
Despite death's starkly famOiar pres- 
ence on the streets and our steely clini- 
cal grit of years of caring for those 
exposed to weather extremes, Alison 
had gotten under our skin: young, 
bright, charismatic, and full of promise. 
We rooted for her to beat the odds. 
Hours of care and concern would sure- 
ly help quiet the Furies that relentless- 
ly pursued her clear across childhood to 
her deathbed on the Common. She had 
borne more sadness, been offered fewer 
choices, and suffered through more 
physical and sexual violence than any 
of us could imagine. Death dashed all 
hope of success, and opened Pandora's 
box anew for us: do our efforts make a 



24 



HARVARD MEDICAL ALUMNI BULLETIN • SUMMER 2000 




difference, or is this litany of suffering 
and death inexorable? 

Caring for homeless people has been 
my fuU'time job for more than 15 years. I 
suspect that the joy I have always found 
in my job bespeaks a deep character 
flaw, a subject puzzled over often with 
my close friend and hero, Pedro Jose 
Greer. A Cuban-American physician 
who has worked miracles in caring for 
homeless people in Miami for years, he is 
rapier-quick in noting that the Irish are 
a people whose sense of impending 
tragedy and guilt through the centuries 
has held them together during brief 
moments of unmitigated joy. While this 
essay could no doubt plumb the former, 
I would prefer to seize the joy. 

A number of unanticipated blessings 
have protected me through the years. 
First, medicine still fascinates me. The 
acuity, complexity, and range of illness 



in the homeless population is bewilder- 
ing, from AIDS and tuberculosis to 
chronic diseases. For those who love the 
science of medicine, the burden of dis- 
ease is compeUing, the need great, and 
the clinical challenges truly exhilarating. 

Second, the long art needed to 
implement the science has an equal 
allure: how do we reach out to bring 
the best of medicine to those who are 
living in abject poverty on the margins 
of our society? 

The nursing profession, so often our 
muse in medicine, imparts a third 
blessing with a simple observation. 
Health care for the disenfranchised is 
predicated upon a one-to-one relation- 
ship made possible only by the invest- 
ment of time and a willingness to ven- 
ture beyond offices and exam rooms to 
unfamihar turf Caring for the homeless 
allows me to engage in many of the very 



OUT ON A LIMB: Intensive outreach to 
those living on the streets ollov/s health 
care providers to develop personal 
relationships with fiercely independent 
people who tend to avoid mainstream 
clinics and other services. 



human activities that had originally 
enticed me into becoming a doctor; to 
listen to stories, to be available, to share 
in sorrows and joys, to ease suffering, to 
make an occasional difference. The lay- 
ered paradox of an urban service deHv- 
ery model that imitates the inefficient 
style of the country doctor is difficult 
to escape: care is best brought to home- 
less people and famihes by "home" vis- 
its — in the shelters and on the streets. 

A fourth blessing comes with learning 
to do no harm. BHCHP doctors often feel 
a paralyzing sense of anger and discour- 
agement during the first year on the job. 
Despite Herculean efforts aimed at find- 
ing safe and affordable housing, the cycle 
of homelessness can seem intractable, 
our efforts hopeless, and our advocacy 
futile. Homelessness is a prism that 
refracts society's most vexing problems, 
and the solution will require fundamen- 
tal reform in housing, health care, wel- 
fare, education, and corrections. When 
our clinicians embrace a goal of heahng, 
the burden of changing Uves evaporates 
in the joy of knowing stories and easing 
pain and suffering. 

The final blessing is an embarrass- 
ment of riches for which I am deeply 
grateful. During residency, I noticed 
that those caring for marginalized 
populations risked becoming margin- 
alized within the medical profession. 
Several guardian angels assuaged my 
fears, assuring me that this would not 
happen. The importance of the colle- 
giality and encouragement of many 
remarkable physicians, teachers, and 
friends cannot be overstated, and I 
offer heartfelt thanks. Indeed, how 
could any life succumb to ennui sur- 
rounded by such munificence? ■ 

James]. O'Conncll '82 is president of the Boston 
Health Care for the Homeless Program and a 
member of the Department of Medicine at 
Massachusetts General Hospital. 



SUMMER 2000 • HARVARD MEDICAL ALUMNI BULLETIN 



25 




^A^^ 




Whether in martial arts training, 

in verse, in prayer, or in flight, 

these physicians have enriched 

their practice of medicine 

by Beverly Ballaro 



RENEWAL 




Christopher "Chip" Baker '74 



CHRISTOPHER "CHIP" BAKER 74 IS A 
Study in contrasts. As a surgeon 
specializing in trauma and crit- 
ical care, he regularly treats the 
aftermath of human adven- 
tures, athletic competitions, and conflicts 
gone awry. Nonetheless, Baker finds himself 
drawn to the same types of high- adrenaline 
pursuits — skiing, scuba diving, and martial 
arts sparring — that can bring his patients 
rushing through emergency room doors. At 
the same time, this third-degree black belt 
in the ancient Korean fighting art of tae 
kwon do cultivates the gentle arts of rose 
gardening, tai chi, and bonsai. 



M.r 



For Baker, it is all a question of balance. 
"Ironically, the experience of growing older 
has made me, in some respects, more like a 
child," he says. "Preserving a sense of won- 
der about the world and dedicating time to 
appreciating nature and people have made 
me a happier person and a better doctor." 

When Baker first began to cultivate an 
interest in the martial arts, he did not envi- 
sion a crossover between this hobby and 
his work as a physician. Yet, in colorful 
writings such as "Zen and the Art of 
Surgery" and "Peregrinations of a Samurai 
Surgeon," he recounts the many ways in 
which his career has benefited from his 
journey to third-degree black belt. "Being a 
successful trauma surgeon requires many 
of the same skills emphasized in the mar- 



WARRIOR SURGEON: By incorporating the 
martial arts into the healing arts, Christopher 
"Chip" Baker '74 has found strategies for 
maintaining his energy and focus in the 
operating room. 



SUMMER 2000 • HARVARD MEDICAL ALUMNI BULLETIN 



27 



tial arts," Baker explains. "Whether 
in the emergency room or the dojo, 
you're operating under the harrowing 
pressure of necessity — of saving 
someone's Ufe or of defending your 
own — and you need to be flexible to 
find solutions." 

The education of young surgeons- 
in-training has provided Baker with 
another source of professional renew- 
al — and another realm in which to 
apply martial arts skills. The training 
paths of white-coated residents and 
white-belted fighting arts novices 
bear striking similarities, Baker 
points out. Both paths instill self- 
confidence, compel students to reach 



for their greatest potential, and 
require extraordinary degrees of con- 
centration and self-discipline. Both 
groups of trainees ascend a hierarchi- 
cal ladder of skill, risk, and responsi- 
bility. And both residents and white 
belts learn first by watching and then 
by doing. 

In martial arts and surgery. Baker 
points out, repetitive practice is cru- 
cial. The tae kwon do novice begins 
with the basic elements of punches 
and kicks and, once these are mas- 
tered, moves on to forms and, eventu- 
ally, sparring. The surgical resident 
learns to tie knots, develops suturing 
skills, and advances to increasingly 



more complicated procedures. Repe- 
tition renders execution second 
nature, thus liberating the mind of the 
martial artist or surgeon to concen- 
trate on making complex decisions 
and responding to the unexpected. 

Baker is a firm believer in the 
power of the human mind, especially 
as it can aid in the healing process. 
"Even though I am a surgeon, I try to 
practice a psychology of wellness," he 
says. "My goal is to help build up my 
patients' energies so that they can 
take control of their recovery. I am 
convinced of the Chinese claim that 
lying in a hospital bed saps people of 
their life force." 




iHati' 




Poet in Motion 



Rafael Campo '92 



WHEN HE FIRST ARRIVED AT HMS, RAFAEL 
Campo '92 found himself questioning the 
path he had chosen. "I was worried," he 
recalls, "that my interest in spiritual hfe 
would brand me an outsider in such a 
science-oriented environment. Then I feared that my Latino 
heritage might present a problem. I was convinced that my 
biggest obstacle, however, would arise from defining myself 
openly as a gay man." As it turned out, none of these aspects 
of Campo's identity caused much of a stir at HMS. "My 
worst offense," Campo laughs, "turned out to be one I had 
never anticipated: being a poet." 

Campo speculates that, to the minds of some, poetry is 
associated with a kind of "touchy feehness" that marks it as 
suspect. More to the heart of the matter, he beheves that 
poetry's power to lay bare the truth disquiets physicians 
who seek to explain phenomena in rational terms. 

But the therapeutic apphcations of poetry, Campo says. Me 
precisely in that border territory where scientific explanations 
and medical interventions fall short. "There is an essential dif- 
ference," he says, "between curing and heahng. Medicine can 
cure many diseases, and that is wonderful. But poetry, while it 
doesn't cure cancer or AIDS, can act as a powerful healing agent. 
This is especially true for patients who have exhausted the lim- 
its of what medicine can offer. When it's just my patient dying 
in a hospice and me, poetry is often the most potent treatment 
available, not just because its rhythms soothe, but especially 
because it tries to make sense of pain and suffering." 



HARVARD MEDICAL ALUMNI BULLETIN • SUMMER 2000 



In Baker's experience, a patient's life 
force or chi, as the Chinese refer to the 
vital energy contained in every living 
being, is no arcane philosophical 
abstraction but a tangible, crucial ele- 
ment in the healing process. Baker him- 
self has witnessed astounding displays 
of this energy by tai chi masters. He 
quickly adds, however, that the healing 
possibilities of such energy are not lim- 
ited to the Eastern masters. 

"The potential exhibited by the 
masters exists within us all," Baker 
says. "Tapping into that same force is 
what empowers a 110-pound woman 
to lift a car that has her child pinned 
underneath." 



As an experienced trauma surgeon. 
Baker understands the pressures of 
being pushed beyond the limits of 
what one thinks is possible. When 
encouraging trauma patients in recov- 
ery, or mentoring surgical residents at 
various levels, he sometimes reflects 
on the time he was attending a martial 
arts testing session and his instructor 
suddenly announced, "Dr. Baker will 
now break four boards with a side 
kick!" He had never actually broken 
more than two boards before and had 
never even attempted four. Nonethe- 
less, Baker was determined neither to 
disappoint his teacher nor to embar- 
rass himself, and broke all four boards 



with ease. Afterward, when he told his 
teacher how startled he had been, the 
instructor smiled and replied, "Pve 
been watching your side kick. I 
thought you were ready." 

"Had someone even suggested to me, 
15 years earher, that I would be breaking 
boards at all, I would have exclaimed, 
'You're nuts!'" Baker laughs. "In surgery, 
whether you're a patient, operating 
room physician, or resident supervisor, 
it's aU about pushing people further 
than they think they can go. And saying 
to a resident, 'You're ready,' and then 
watching that individual outperform 
expectations is one of the great satisfac- 
tions of a career in academic surgery." 



Although he had consciously dis- 
tanced himself from poetry in college 
and at HMS, Campo reforged this vital 
link during his residency when he had 
to confront human suffering firsthand. 
One of the first patients he encountered 
was a Latina grandmother whose breast 
cancer had already widely metastasized 
by the time she met Campo. In addition 
to sources of medical research about 
breast cancer, Campo suggested to her 
works by poets who portrayed their 
own struggles with the disease. To 
Campo's surprise, his patient arrived at 
their next appointment bearing her 
own poetry. The writing process, she 
told him, had given her great satisfac- 
tion and purpose, despite her poor prog- 
nosis. When she died, she left her 
poems to her grandchildren as a cher- 
ished record of her Me. 

The connection between poetry and 
heahng, as weU as the tremendous sense 
of rejuvenation poetry has brought to 
Campo and his patients, are themselves 
born of Campo's own process of renew- 
al. "When I'm feeling drained, frustrat- 
ed, and overwhelmed by the profes- 
sion — by technology, HMOs, time con- 
straints, and other pressures — poetry 
can really help refocus my energies," he 
says. "Even though the creative process 
itself can be taxing, the revitalization 
that comes out of it more than makes up 
for that expenditure of energy." 



For Campo, the writing process 
facihtates a kind of rebirth in which he 
deliberately sheds his white -coat iden- 
tity and opens himself to his patients 
and their stories of pain and suffering. 
"As a physician," he says, "you need, of 
course, to maintain a certain distance 
between yourself and the pain of your 
patients. Yet I find that we can take the 
desire to avoid over-identification too 



"My worst offense," 
Campo laughs, 
"turned out to 
be one I had 
never anticipated: 
being a poet.' 



r>i 



far, and we end up sealing ourselves off 
to an unhealthy degree. Poetry allows 
me to question these types of bound- 
aries and, ultimately, puts me in better 
contact with my patients' experiences." 
Campo's patients are well aware that 
their doctor is also a prominent poet; 
indeed, many of them seek him out pre- 
cisely for that reason. Campo strongly 
believes that the medical profession 
urgently needs to integrate science and 



the humanities as complementary disci- 
plines. "We're entering an era of scien- 
tific discovery that is thrilling, empow- 
ering, and yet dangerously prone to 
hubris," he says. "The knowledge base is 
expanding every day, yet the further we 
go in explaining all there is to know 
about what makes us human, the 
greater the risk of cold-hearted, pas- 
sionless care. I welcome the path of 
inquiry that wiU, no doubt, lead us to 
cures for some of our most dread dis- 
eases. I just want to reinterpret science 
in poetic terms so that we can preserve 
some sense of mystery and wonder." 

While celebrating medicine's search 
for exciting new therapies, Campo 
continues to embrace the ancient heal- 
ing balm of poetry. He met one of his 
first patients, he recalls, over the 
course of several long hospital stays. 
The patient was a young man, suffering 
the effects of various end-stage AIDS 
diagnoses, including cytomegalovirus 
retinitis, which had impaired his 
vision. With little to offer his patient in 
the way of a cure, Campo used to stop 
by his room late at night and read poet- 
ry aloud to him. "Science may, one day 
give us the technical tools and knowl- 
edge to understand and prevent — or 
cure — tragedies such as this," he says. 
"But the human healing connection 
made in such an encounter will always 
belong to a different, timeless realm." 



SUMMER 2000 • HARVARD MEDICAL ALUMNI BULLETIN 



29 



Fatthful Healer 



Renee Gardner '7b 



IN CARING FOR HER YOUNG CANCER PATIENTS, RENEE GARDNER '75 
relies on advances in modern medicine and leaps of ancient faith. 
Treating children for serious, sometimes terminal, illness requires 
cutting' edge knowledge of a rapidly evolving discipline, as well as a 
hardiness of spirit that cannot be taught in medical school. 
"In the field of pediatric oncology," says Gardner, "an extraordinary degree 
of intimacy builds up between you and your patients. You're following some 
of them over a very extended period of time, and you're dealing with issues 
that are hterally about life and death. You've got to be willing to let yourself be 
touched by sadness and tragedy. But more than that, you have to be able to 
take a punch emotionally and remain standing." 

For inspirational models, Gardner need look no further than her own young 
patients. "I generally find kids to be very courageous," she says. "Even young 
children can grasp what's at stake when they're seriously iU. Actually, in my 
experience, kids often handle hfe-threatening disease better than adults. 
Adults tend to have a lot of fatalism. But children, and teenagers in particular, 
just don't accept the prospect of death as quickly and readily." Ironically, 
Gardner speculates, adolescents' weU-known belief in their own immortahty, 
which can lead to disaster in other contexts, can become a source of remark- 
able hope and resilience in the face of a cancer diagnosis. 

Fortunately for Gardner's patients, such a diagnosis no longer necessarily rep- 
resents a death sentence; bearing witness to many patient success stories over the 
years, Gardner says, has played a key role in keeping her spirits and motivation 
high. While her greatest frustration remains diseases such as neuroblastoma and 



alveolar rhabdomyosarcoma, for which 
the grim prognosis has changed httle in 
over a century of medical research, she is 
heartened by overall statistical trends. 

She points out that, nowadays, for aU 
types of childhood cancer, children have 
a 70 percent chance of beating their dis- 
ease. With some cancers, the odds of 
survival can run as high as 90 to 95 per- 
cent. And the numbers only promise to 
improve. Gardner is particularly excited 
by the prospects opened up by the 
decoding of the human genome. 

Yet how does this oncologist cope 
with the inevitable discouraging 
moments? Despite the stunning medical 
advances achieved this past century, and 
the promise of future scientific break- 
throughs, there remains no shortage of 
challenges where medicine and science 
fall short. "I'm no wonder woman," insists 
Gardner. "I'm not always successful, and I 
do get tired. It can be very hard, very emo- 
tionally draining to lose young patients in 
quick succession. But looking within, 
and holding fast to my spiritual beHefs, is 
what enables me to stay focused and keep 
moving forward." 

For Gardner, a rock-sohd Christian 
faith represents her most important 
source of energy for sustenance and 




Higher Flyer 



David Mauritson '74 



WHY WOULD PATIENTS SUFFERING FROM ARTHRITIS, 
burns, or cancer turn to a cardiologist for help? 
When the cardiologist is David Mauritson '74, 
the delivery of care takes the form of the dehv- 
ery of patients. 
For the past seven years, Mauritson has donated his ser\Tces as a 
volunteer pilot with AirlifeLine and, more recendy, v^dth Angel FUght 
Southeast. He averages six flights a year and has flowTi more than 40 
missions since he began volunteering. His colleagues at Cardiology 
Associates of West Alabama have been generous in covering for him, 
to allow him to fly the missions. "I enjoy doing it, and I know I'm real- 
ly helping people," Mauritson says. "The reward comes from assisting 
people in need and indulging in a passion — flying — in the process." 

AirlifeLine is a national nonprofit organization based in Sacramen- 
to, California. Its pilots transport seriously ill patients who cannot 



HARVARD MEDICAL ALUMNI BULLETIN • SUMMER 2000 



renewal as a physician and as a 
human being. The integration of 
her spirituality into her approach 
to patients flows naturally from 
her conviction that, as a Christian, 
she must strive to serve as an exam- 
ple of kindness, love, and compas- 
sion. What better opportunity to 
translate spiritual values into 
action than the care of very sick 
patients and their famihes? 

One of the toughest such oppor- 
tunities arises when Gardner must 
break bad news to parents. "I'm 
always totally honest with them, 
and some of them can find the 
information devastating," she says. 
"But I hke to remind them that, 
despite the statistics weVe com- 
piled on overall cancer cure rates, 
every indmduaVs chances of survival 
he somewhere between zero and 100 
percent. This leaves open an avenue of 
hope, because it's impossible to predict 
who's going to be a survivor. I promise 
them that our team will give their 
child's treatment our best possible 
effort, and then leave the rest to God." 

In negotiating the boundaries of sci- 
ence and faith, Gardner joins an explo- 
ration shared by many patients' famihes. 




"I generally find kids to be 
very courageous. Even 
young children can grasp 
what's at stake when 
they're seriously ill." 



"Very often," Gardner says, "I encounter 
parents who are desperately grasping 
for answers, for hope. They may never 
have beheved that faith is real; they may 
feel that their faith is now being seri- 
ously tested for the first time in their 
lives. In most cases, they are seeking 
some kind of anchorage." 

To mitigate their bewilderment and 
despair, Gardner offers her perspectives 



both as a physician and a Christian. 
"I tell them that we are limited in 
terms of our oudook. It may well be 
beyond our human comprehension 
to understand what higher purpose, 
if any, a child's suffering ser\'es." 

Despite the harsh reahty that not 
all children with cancer survive, 
Gardner interprets the process of 
caring for and befriending these 
children and their families as a 
blessing. Regardless of the outcome, 
she feels, she and the hospital staff 
are richer for having knov/n them. 

And occasionally, just occasion- 
ally, the unfathomable suffering of 
children can lead to sublime, some 
might argue divine, reprieves. "I 
had a patient," recalls Gardner, 
"who was diagnosed with B-ceU 
leukemia at age eight. Scientffic 
models gave him only a 25 percent 
chance of surviving, yet he celebrated his 
13th birthday disease-free. I have anoth- 
er patient who presented, at age 16, with 
a cancer that had originated in his brain 
and then metastasized to his bones. 
According to all the medical hterature, 
this young man should be dead. But he is 
now 22 and thriving. And, yes, I guess 
you could caU that a miracle." 



afford the cost of commercial travel to 
medical facihties far from home. More 
than 1,000 volunteer pilots from aU walks 
of life donate their time, skills, planes, and 
fuel. Patients must be ambulatory and 
able to travel in an unpressurized plane 
without medical personnel or equipment 
during the flight. They are allowed to 
bring along one family member or sup- 
port person, although, in the case of a sick 
child, both parents may travel. 

Mauritson has flown all manner of 
patients to all types of destinations. He 
has taken people to Texas for chemo- 
therapy and to North Carolina for arthri- 
tis treatments. He was once called upon 
to fly the first segment of a multi-leg jour- 
ney for a young Boston man whose shat- 
tered femur had left him stranded in Mis- 
sissippi with no way of returning home. 

Children, Mauritson says, have pro- 
vided him with his most touching expe- 



riences as a volunteer pilot. He has trans- 
ported a fair number of youngsters 
under the age of ten to the Shrtners Burn 
Institute in Galveston, Texas. Setting 
children hteraUy on the journey to recov- 
ery — and the promise of a healthier 
future — fills Mauritson with hope and a 
powerfully renewed sense of purpose. 

This spirit of renewal is shared by the 
famihes whose gratitude is outweighed 
perhaps only by the excitement of Mau- 
ritsoris young passengers. For many of 
them, exploring the wild blue yonder in 
his Commander 114 four-seat, single- 
engine plane represents the first flight 
they've ever taken. "Amazingly," Maurit- 
son says, "not one patient has ever got- 
ten airsick on one of my missions." 

The smooth flights reflect skiUs born 
of long experience, stretching back to 
Mauritsoris teenage days. For Maurit- 
son, flying has always been a family 



affair. He took his first flying lessons at 
the age of 16 from his mother, a flight 
instructor and inductee into the Okla- 
homa Aviation Hall of Fame. His father 
was also a pilot — as well as a physician. 
Mauritson has passed the gfft of flight 
on to his own son and daughter, both of 
whom are licensed pilots. His wffe, he 
adds, is the only member of the family 
not eager to climb behind the controls 
of a plane. 

Mauritson would hke to generate 
more awareness among physicians of 
the services provided by volunteer pilot 
groups such as AirlifeLtne and AirAl- 
hance, the loose association of various 
national and regional groups. "And, nat- 
uraUy," he adds, "we're always looking 
for a few good pilots to volunteer." ■ 

Beverly Ballaro is assistant editor of the 
Harvard Medical Alumni Bulletin. 



SUMMER 2000 • HARVARD MEDICAL ALUMNI BULLETIN 



31 



^ 



'IP f$ 



1 



After decades of treating patients, these 
doctors retired from medicine to pursue 

new passions: turning hubcaps into warriors, 
delivering homilies to parishioners, and 

transforming glass into miniature gardens 

by Phyllis L. Fagell 



\V 




Hardy Jones '73 

AFTER A SUCCESSFUL 20-YEAR 
career as an orthopedic sur- 
geon, sculpting bone to exact 
specifications, Hardy Jones 73 
has delved into a much less pre- 
cise art form. These days, he crafts asymmetri- 
cal creatures, welding scrap metal into whim- 
sical dragons, dancers, unicorns, and fish. 

"Orthopedic surgery and the type of metal 
sculpting I do are similar in many ways," 
Jones says. "They both involve working with 
my hands, and I use an artistic judgment in 
solving problems orthopedically. In orthope- 
dics, though, patients aren't quite as thrilled 
when their legs aren't the same length." 

The story of Jones's journey from operating 
room to art studio began in 1967. Just months 
before he was supposed to attend HMS, a dev- 
astating motorcycle accident injured his brain 
stem, crushed his left leg, and left him in a 
coma for two weeks. "When I woke up," Jones 
says, "I was paralyzed on the right side of my 
body, and I had slurred speech and significant 
memory loss." His long recuperation and 
experience as a patient, he adds, "significantly 
contributed to my choice of a medical special- 
ty and my style of practice." 

Jones fuUy recovered from the neurological 
injuries, and he finally made it to HMS two 
years later. His orthopedic problems, howev- 
er, were chronic. "I had complications that 
required long-term antibiotics and repeat 
surgeries," he says. As a medical student, he 



SHIFTING GEARS: Hardy Jones '73 stands 
in front of "Junk Yard Dragon." Each of his 
sculptures Is unique, composed of metal 
parts ranging from plov\^ disks to faucet 
handles to truck and railroad yard fittings. 



SUMMER 2000 • HARVARD MEDICAL ALUMNI BULLETIN 



33 



ART ATTACK: Jones's 
sculptures "Pony Express 
(top) and "Pescodo 
Angelito" (bottom). He 
rearranges and welds 
metal parts to bring 
his creations to life 
as dancers, animals, 
or warriors. 




was on crutches for two years and 
briefly used a wheelchair. 

Despite his physical challenges, Jones 
launched a productive and rewarding 
career as an orthopedic surgeon, becom- 
ing chair of his department at Santa Clara 
Kaiser. "I was able to practice the type of 
medicine that brought me happiness, not 
only in terms of the professional chal- 
lenge, but also in terms of keeping promis- 
es I had made to myself when I was a 
patient," he says. "I think I was a kind and 
gentle physician, and I have no regrets." 

Jones knew, however, that his body 
might not always be able to keep up 
with the physically demanding schedule 
he kept as a surgeon. "I was told 30 years 
ago that I would have problems later in 
Life, and now I'm hving later in Me," he 
says. "I'm paying the price of significant- 
ly worn hip and knee joints." 

Since his retirement at age 52, Jones 
says, "My cup has runneth over. I now get 
to foUow the road not taken. I feel freed 
emotionally and spirituaUy to pursue my 
artistic desires without a guilty con- 
science. I enjoyed the patient contact, the 
teaching, the collegial interaction, and 
the stimulation of medicine. But I also 
was able to go out on top, with people 
standing and clapping, rather than focus- 
ing on my increasing limitations." 



The transition was 

made with the support 

of his wife, Jane, whom he 

married the summer he 

began medical school. "We have raised 

our children, launched our careers, and 

traveled through life together," he says. 

"She helped me organize my options and 

ultimately retire from medical practice." 

Although Jones has no formal art train- 
ing, in a sense he has been studying 
found-metal sculpture his entire Me. As a 
child, he would leave the beach with his 
pockets fuU of pebbles, or return from 
railroad tracks lugging spikes, washers, 
screws, and bolts. "Artists who paint 
need easels and palette boards — all the 
purples, blues, and oranges," he says. "I 
have a junk pile." Just as he did as a boy, he 
ventures into the country for Ms materi- 
als, scouring old barnyards for automo- 
tive parts, industrial scrap metal, broken 
farm equipment, and discarded tools. 
"Prospecting for rusty metal treasures is a 
crucial part of my art career," he says. 

Jones's life-size pieces are neither 
abstract nor entirely realistic. In one of 
Ms sculptures, a warrior's sMeld is a 
hubcap, Ms right arm the steering link- 
age from a Chevrolet, and Ms knee cap 
a tractor gear. Jones once created a 
half-acre piece called "Rock Band" 
made out of old stove parts, telephone 
cable, and large chunks of driftwood. 



These days, Jones works out of Ms 
home, usmg doMes to move sculpture 
and working at a welding bench. "I've 
managed to design my art studio so I 
don't have to do any heavy lifting," he says. 
Over the years, he has made hundreds of 
sculptures and won numerous awards. 
More than 20 of Ms pieces are displayed 
in pubhc places in Santa Clara County 
and the Silicon Valley, where he lives. 

"I try to capture the essence of an 
animal or dancer, the spirit of the piece, 
without effort, to have it just pass 
tMough me," Jones says. "It's a delight 
when I have fimshed a sculpture and 
can enjoy the outcome." 

Although sculpting a prosthesis to fit 
a deformed joint can be as creative as 
sculpting metal, Jones says, "the differ- 
ence is the intensity. My art is open- 
ended and flexible. Orthopedics is rig- 
orous and uMorgiving, and you can't 
walk away from your mistakes. In my 
art, I'm often working on tMee or four 
sculptures simultaneously, and I can 
leave one or more uMimshed until I find 
the right part for it. It's not a stress, it's 
a discovery, and a counterpart to the 
intensity of a medical career. 

"I made two great decisions in my 
career," Jones adds. "One was to go into 
medicine, the second was to retire from 
medicine. I regret my body's limitations, 
but I now have a wonderful opportumty." 




HARVARD MEDICAL ALUMNI BULLETIN • SUMMER 2000 




Higher i^a^/w^ 

Richard Senghas '54 

AFTER MORE THAN 3O YEARS OF PRACTICING MEDICINE, RICHARD 
Senghas '54 now answers to "Father" instead of "Doctor." Once 
an orthopedic surgeon, now a Roman CathoUc priest and pas- 
tor of St. Rose of Lima Church in Jay, Maine, Senghas says he 
reahzes "it's not a common life, having worked as both a physi- 
cian and a priest." He was called to the ministry after his wife, 
June, also a member of the Class of 1954, died in 1993. They had met at HMS in 
anatomy class, when they worked on neighboring cadavers. "After June died, I 
realized, much to my surprise, that I could be happy as a celibate," Senghas says. 
"And then I realized I might be called to be a priest. It was a gradual realization." 
The transition was natural, Senghas adds. "Both are people-oriented voca- 
tions. As a priest, I'm here to bring the sacraments and the word of God for the 
spiritual life of my people. As a physician, I worked to improve my patients' 
physical condition. My medical experience makes me more inclined to think 
about what is going on under the surface in my parishioners, from their family 



life to their physical condition to their 
mental state." 

Because of his medical background, 
Senghas also feels at ease visiting parish- 
ioners in the hospital. Sometimes, he says, 
he even fiads himself staring at their 
monitors, but he is careful not to turn 
parishioners into patients. "I've had many 
suspicions of diagnoses, either mental or 
physical," he says. "If I see parishioners 
who need medical care, I wiU encourage 
them to seek help. Once in a while, a 
parishioner will ask me a medical ques- 
tion, but I just srmle and say, 'Sorry I've 
given up my hcense.' You can't mix the 
two professions. With the demands of 
the priesthood and medicine, it would be 
difficult to do justice to them both." 

Senghas says he felt no great struggle 
about leaving medicine behind. "I miss 
the farmharity of medicine the way you 



SUMMER 2000 • HARVARD MEDICAL ALUMNI BULLETIN 



35 



36 



miss an old friend," he explains. "It was 
gratifying helping people, although 
when the telephone rings at one in the 
morning with an announcement that 
there are three seriously injured people 
with open fractures, those are not 
moments of happiness. But I didn't get 
tired of medicine; I simply had a sec- 
ond caUing to the ministry. It is equal- 
ly satisfying for me to heal someone 
spiritually as physically." 

Senghas began his four-year pro- 
gram as a seminarian at the Pope John 
XXIII National Seminary, a program 
for older men, in 1995. "There were 
doctors, lawyers, and professors in my 
class," Senghas recalls. "For all of us it 
was a calling." He shared accommoda- 
tions with a former pathologist who 
also was a widower. "I think they put 
us together so that if we talked shop, 
we wouldn't offend the others." 

The program was rigorous, Senghas 
adds. "In the same way that a physi- 
cian studies sciences such as pharma 
cology, physiology, and psychology to 
help patients, a priest integrates the 
studies of theology, ecclesiology, and 
scripture to work with parishioners. 
In both medicine and the ministry, 
this integration takes place on an 
almost intuitive level. You need acade- 
mic skills in both vocations, but you 
also have to be able to work with oth- 
ers in a close, personal way." 

Senghas's seven grown children 
and 12 grandchildren have been very 
supportive of his decision, but one 
grandchild was disconcerted by Seng- 
has's ordination ceremony. "I had to 
lie face down in front of the altar for 
part of the ceremony," he says, "and 
one of my grandsons, sitting in the 
front row, called out, 'Is Grandpa 
okay? Someone go help Grandpa!'" 

Occasionally, Senghas's past life as a 
married doctor has confused parish- 
ioners. "One woman who came to Mass 
stopped suddenly at the door," he says. 
"She thought she had gone to the 
wrong church because she heard me 
mention my wife in my homily." 

Throughout both careers, Senghas 
adds, "the most important thing in my 
hfe has been my faith. I'm just more 
aware of it now. Even later in life, we 
have to remain open to what God is 
calling us to do." 



HARVARD MEDICAL ALUMNI BULLETIN • SUMMER 2000 




Artistic ^Mj^ne^z^a/^ 



Lois Barth Epstein '59 

AFTER 27 YEARS OF PRACTICING MEDICINE, LOIS BARTH EPSTEIN 
'59 traded in her stethoscope for a propane-fueled torch 
and her laboratory for an art studio. She now works full 
time as a flameworker, transforming molten glass into del- 
icate flowers and intricate objects. "I derived tremendous 
gratification from my academic career," Epstein says, noting 
that her interests spanned basic science, cancer research, pediatric immunol- 
ogy, administration, and teaching at the University of California at San Fran- 
cisco. But her focus changed in 1993, when her husband, Charles Epstein '59, 
a geneticist and former editor of the American pumal of Human Gmctics, was 
nearly killed by a bomb sent to their house by the Unabomber. "I felt I need- 
ed to spend more time with Charhe and help in his recovery," she says. 

Epstein took early retirement and turned to glassblowing, an art she had 
first encountered two decades earher, when she took a course at the London 
Glass House. "I remember my husband and three sons cheering me on as I 
swung a blow pipe around to make a colorful plate," she says. But it wasn't 
until 1989, when her mother died, that she began working with glass again. "I 
was so deeply affected by her death that I felt I needed to do something with 




my hands to help with the grieving 
process," Epstein says. While stiU main- 
taining an active career in medicine, she 
took a course in stained glass. She then 
was accepted into the Pilchuck Glass 
School near Seattle, where she learned 
coldworking — how to sandblast and 
engrave on glass — and began designing 
pieces for other glassblowers to create. 

Then, in 1993, while Epstein was on a 
site visit in Cleveland, she was called 
out of a meeting. "A neighbor phoned to 
tell me that a bomb sent through the 
mail had exploded in Charhe's hands," 
Epstein recalls. "He told me he wasn't 
sure if Charlie would survive." She 
immediately flew home to San Francis- 
co. "When I arrived, the first thing I saw 
was a newspaper with a photograph of 
our shattered kitchen on the front page. 

"Charhe was in surgery for nine 
hours," Epstein says. "He later had three 
surgical procedures to make new 
eardrums, since the explosion had left 



him totally deaf." Subsequently, an 
eleven-hour nerve transplant operation 
restored some function to his right arm. 
"For the first two years after die acci- 
dent," she says, "my total preoccupation 
was helping my husband." 

Epstein decided to return to Pilchuck 
to learn how to make mosaics with glass 
tiles. To inspire Charlie, who had been an 
accomphshed cellist, she made him a 
mosaic cello. "Symbohcally, I wanted to 
hand him back his cello in the hope that 
one day he would play again," she says. 
The creative process was therapeutic, just 
as it had been after her mother's death. 
"When you're working with your hands, 
you lose yourself in what you're doing." 

Today, despite the fact that he lost 
the tips of several fingers on his right 
hand, CharHe plays the cello in the 
Bohemian Club Orchestra in Califor- 
nia. "He's a bionic man," Epstein says. 
"He's been restored, but he will have 
physical therapy on his hands for the 



rest of his life. Luckily, his mind was not 
affected, and he has shown tremendous 
courage throughout all of this." 

As Charlie recovered and Epstein 
delved more deeply into her new career, 
she felt she needed to home in on a spe- 
cific type of glass art. "I was over 60, and 
it was hard work to lift the pontil, the 
tool used to gather molten glass from the 
furnace," she explains. "I simply wasn't 
agile or strong enough to do glassblow- 
ing on a large scale." So she decided to 
study flameworking — using a torch to 
make objects from molten glass — at the 
Penland School of Crafts and the studio 
at the Corning Museum of Glass. Then 
she set up a studio in her garage, com- 
plete with a propane- and oxygen-fueled 
torch, annealers, and vented hood. 

Epstein is now working on a glass gar- 
den and mosaic tile floor for a dollhouse 
that Charlie is buildtng. Although many 
people have tried to commission her 
work, "I have not accepted any yet," she 
says. "I am trying to build a body of work 
to exhibit that has been developed in my 
own studio, rather than in a school." 

Epstein has on occasion questioned 
her career shift. While in residence at the 
ViRa SerbeUoni — a study center in Bella- 
gio, Italy, for academicians from around 
the world — she found herself sitting at 
dinner between two men actively 
involved in public health in Bangkok. "I 
explained to them that the gratification I 
get from doing art is very personal and 
self-absorbed, whereas in medicine I 
helped many more people and my impact 
was greater," she says. "One of the men 
told me that in Buddhism, art is healing, 
not only for those who produce it, but 
for those who appreciate its beauty. He 
was trying to explain that there isn't nec- 
essarily a disconnect between medicine 
and art." Yet after spending that evening 
discussing the problems of health care 
dehvery in developing countries, Epstein 
realized that "even though I'm 66, 1 might 
see what opportunities are available to 
me in the field of international health. 

"People need to follow their dreams," 
she adds. "If they have an artistic bent, 
or are into literature or religion, they 
should go for it. There are opportunities 
for several careers in a lifetime." ■ 

Phyllis L. Fagdl is associate editor of the 
Harvard Medical Alumni Bulletin. 



SUMMER 2000 • HARVARD MEDICAL ALUMNI BULLETIN 




by Eric B. Larson 







By drawing on the same techniques that foster successfu 
aging, doctors can thrive — not just survive — in medicine 



PHYSICIANS TODAY FREQUENTLY FIND THEMSELVES 

embattled, clinging to professional survival, or 
even ready to abandon the medical field in frustra- 
tion and despair. Yet doctors searching for ways to 
adapt to recent dramatic changes in medicine can 
turn to a surprising new source. Lessons gleaned 
from research into aging can offer models for thriv- 
ing, not just surviving, in medicine. 



38 HARVARD MEDICAL ALUMNI BULLETIN • SUMMER 2000 



Scientists and lay people can view 
the term "successful aging" quite dif- 
ferently. Perhaps the most basic ele- 
ments of any such definition are main- 
taining satisfaction and retaining con- 
trol of one's life. But successful — as 
opposed to usual — aging may require 
more specifically the abilities to mini- 
mize decline and to adapt effectively 
to change and loss. Some people may 
even experience what might be 
termed "optimal" aging; they are able 
to maintain elite levels of performance 
and function as they grow older. 

Similarly, individual interpretations 
of what it means to thrive in medicine 
can color physicians' feelings about 
their work. Most doctors would iden- 
tify a sense of gratitude for the privi- 
lege of being a physician and a com- 
mitment to the mission of medicine as 
fundamental to the definition of 
"thriving." Beyond the basics, howev- 
er, there are many possible ways 
to expand this definition. In one 
poignant example, a general physician 
in a small Wisconsin town found him- 
self in a state of despair shortly after 
he retired. When he discovered that 
he could apply his profound medical 
knowledge and familiarity with his 
community to teaching and volunteer- 
ing, he experienced a rebirth of his 
self-worth and a restoration of his 
identity as a professional. 

Measures of Success 



Longitudinal studies of physical func- 
tion in aging have shown that steady 
dechne is not an inexorable reahty: as 
we grow older, we go through periods 
of improvement as well as periods of 
decline. Productivity for some tasks 
may actually increase with time and 
experience. Catastrophic illness, psy- 
chosocial factors, and changes in mas- 
tery — rather than chronological age 
per se — all play pivotal roles. Yet if pro- 
ductivity is an important metric for a 



physician, it is not the only one; cer- 
tainly income should not be the most 
important driving force or measure of 
professional success. Physicians who 
do not want to be disappointed in 
today's marketplace may need to focus 
on the quality of patient care, which 
often depends not only on their learn- 
ing new skills and information, but 
also on their being able to do more for 
patients as medical science continues 
to provide better treatments. 

Other factors that play key roles in 
thriving include physical exercise, emo- 
tional support from social networks, 
and purposeful activity. Although one 
might expect physicians, of all people, 
to recognize these needs, there is abun- 
dant evidence, both in the hterature 
and from direct observation, that many 
professionals ignore their own needs. 
Why? It may be that, because of our 
medical training, we tend to work 
harder in order to be more productive 
and thus fail to make the time to culti- 
vate the healthy habits that can, ironi- 
cally, help boost our productixaty 

Two of the most important deter- 
minants of both successful aging and 
physician satisfaction are muscu- 
loskeletal function and cognition. The 
preservation of musculoskeletal func- 
tion requires regular physical activity, 
self-management techniques — espe- 
cially to combat osteoarthritis — 
and avoidance of the inactivity that 
such psychomotor drugs as benzodi- 
azepines and alcohol can promote. 
Maintaining good health also helps 
preserve cognitive function; on this 
front, at least, physicians have a good 
head start, since educational achieve- 
ment is one of the strongest predictors 
of cognitive function. To build on our 
advantage and enhance our ability to 
thrive, we should commit ourselves to 
lifelong learning through self-directed 
study, formal continuing medical edu- 
cation, or research. Emotional health 
factors play an important role as well: 



depression and anxiety are associated 
with lower cognitive function, where- 
as self- efficacy — the confidence that 
one has the skills and ability to take 
care of oneself — predicts the opposite. 
Meaningful, habitual professional 
activity, continued involvement in 
medical societies and medical staff 
activities, and the preservation of pro- 
fessional autonomy also are critical 
to physician satisfaction. Community 
involvement allows doctors to avoid 
marginalizing themselves or being 
marginalized by others. Retired physi- 
cians can tap into their knowledge and 
skills in innumerable ways, as illus- 
trated by the Dover Free Clinic, estab- 
lished by Robert Zufall '47 and his 
wife, Kay. The cUnic primarily relies 




P.O. Box 2035 
Healdsburg, CA 95448 
Phone:707-431-8835 
Fox: 707-433-8092 
Email: rpolidora@lake.org 
Aviva! Wellness Institute's major 
program, "Self-Care Skills for 
Physicians: Balancing Service 
and Self-Care," is an experien- 
tiol training program for physi- 
cians and physician<ouples. •; 



37922 55th Avenue South 
Auburn, WA 98001 
Phone: 253-351-8577 
Fax: 253-351-8576 
Email: mdrenew@aol.com 
The Center for Physician Renew- 
al, founded by Todd Pearson, 
MD, is devoted to helping peo- 



40 



HARVARD MEDICAL ALUMNI BULLETIN • SUMMER 2000 



contribute, not just on our material and professional needs. 



on recently retired physician-volun- 
teers to serve a predominantly Latino, 
uninsured community outside of 
Newark, New Jersey. The Zufalls have 
described their work there as the most 
gratifying professional activity of their 
entire lives. 

Keeping up morale is another impor- 
tant strategy for maximizing quality of 
life. Older people who maintain good 
morale tend not to base their self- 
esteem on comparisons with others. 

Maintenance of certain social net- 
works also is crucial for those who age 
successfully, although the size of the 
network is not as important as the 
selectivity and quahty of the interac- 
tion. Avenues for both giving and 
receiving support are critical. In one 



study, helping others was the strongest 
predictor of self-esteem. Finally, reh- 
gion often provides meaning in the face 
of uncertainty. 

Achieving Equanimity 

As the world of medicine continues to 
evolve, we will need to choose our 
goals carefully — working to improve 
what is amenable to change, occasion- 
ally accepting things we do not like, 
but always persevering in our mission. 
Ideally, we will also recognize what 
cannot be changed, ensuring that the 
goals we set are attainable. 

Medicine remains a great profes- 
sion, loved, for the most part, by those 
fortunate enough to be physicians. 



particularly those committed to ser- 
vice, science, and professionalism. To 
thrive in medicine, of course, we must 
focus on what we can contribute, not 
just on our material and professional 
needs. This means that, for our patients 
as well as ourselves, we should take the 
time to maintain and improve our 
knowledge and skills, as well as our 
physical and emotional health. And in 
hard times, we must strive to achieve 
that unique quality — equanimity in 
our profession. ■ 

Eric B. Larson 73 is medical director of the 
University of Washington Medical Center in 
Seattle. He is also associate dean for clinical 
affairs and professor of medicine in the Univer- 
sity of Washington School of Medicine. 



pie and health care organi- 
zations reconnect to their 
most authentic sense of 
identity, meaning, and pur- 
pose. The center is dedicat- 
ed to those interested in cul- 
tivating personal and pro- 
fessional renewal, and in 
deepening their understand- 
ing of the link between their 
inner lives and engagement 
with the outer world of ser- 
vice and their life work. 




555 Bryant Street 

Suite 1 60 

Palo Alto, CA 94301 

Phone: 800-377-1096 

Fax:650-329-1887 

wv/w.cppr.com 

The Center for Professional 



and Personal Renewal is 
devoted to the support and 
revitalizction of health care 
professionals and organi- 
zations. Founder and direc- 
tor Peter Moskowitz, MD, 
offers a range of services, 
including on-site and 
remote career and life 
coaching for physicians 
anticipating career transi- 
tion, workshops and semi- 
nars, and consultation to 
health care organizations. 



2 1 West Colony Place 
Suite 150 

Durham, NC 27705 
Phone: 919-489-9167 
Fax: 919-419-0011 
v/ww.cpwb.org 




The Center for Profession- 
al Well-Being, directed 
by John-Henry Pfifferling, 
PhD, provides practice 
diagnoses, coaching, 
and counseling assis- 
tance to promote physi- 
cian morale and revital- 
izction, and to reduce 
the risk of compassion 
fatigue and burnout. 



99 Babcock Street, Suite 2 
Brookline, MA 02446 
Phone: 617-713-3688 
Fax:617-713-3776 
v/ww.mdintellinet.com 
MD IntelliNet, under the 
leadership of Gigi Hirsch, 
MD, helps physicians 
enhance their professional 
satisfaction through 



career diversification and 
transitions into non-patient 
care roles within health 
care. MD IntelliNet pro- 
vides part-time and full- 
time placement opportuni- 
ties, as well as strategic 
career consultations. 



P.O. Box 829 
Topeka, KS 66601 
Phone: 800-288-5357 
Fax: 913-648-3155 
www.menninger.edu 
The Menninger Leader- 
ship Center offers semi- 
nars, workshops, and 
consultations for physi- 
cians who are in transi- 
tion, under stress, or bal- 
ancing work and family. 



^ 
^ 



CD 



SUMMER 2000 • HARVARD MEDICAL ALUMNI BULLETIN 



41 



fWdiftiiKJH%"^l.K->' Vfl'.Ji'r&'»™ii.„-^. 




WHEN HMS WENT TO 

WAR 



In \AAA/II, d generation of Harvard doctors answered the cal to duty 



"BRILLIANT U.S. SURGEONS STAFF ARMY HOSPITAL," TRUMPETED THE JULY 24, 1942 

headline of Brisbane, Australia's local newspaper. "One of America's most 
brilliant collection of surgeons and physicians," the article gushed, "is 
gathered in a small northern town ready to operate in what will be one of 
the largest hospitals, civil or army, in the southern hemisphere. They are 
members of the famous Harvard unit, and each is a professor in his par- 
ticular branch of medical science. 

"The Harvard unit is regarded as one of the finest bodies of medical men 
ever to have left the United States," the article went on to state. "Many 
of the surgeons have carried out or consulted at operations on famous 
Americans, but are loathe to discuss them, shying violently when 
[asked] if perhaps they had treated world figures such as film stars." 



by Beverly Ballaro 



^ I Bemused members of the 105th General Hospital quickly adopted 



Bemused members of the 105th Gen- 
eral Hospital quickly adopted "Every 
man a professor!" as their tongue-in- 
cheek rallying cry. Despite their self- 
effacing attitude, the physicians who set 
sail for Austraha in May 1942 were a 
proud and determined group who 
served their country throughout the 
Second World War. They represented 
the largest group of HMS doctors ever 
to go overseas as a general hospital, and 
quickly gained fame in the Southwest 
Pacific as "The Harvard Unit." 

Paper Tiger 

The 105th General Hospital traced its 
origins to a time well before Pearl Har- 
bor precipitated the American entry 
into World War II. It began as the 
brainchild of a group of men drawn 
from the staffs of HMS and its associ- 
ated hospitals, including some veter- 
ans who had served as junior members 
with the Harvard- affiliated 5th Base 
Hospital in France during the First 
World War. These men met in the 
Peter Bent Brigham Hospital auditori- 
um and began drawing up plans for a 
new general hospital, modeled after its 
World War I predecessor. By 1940, 
HMS had submitted to the surgeon 
general of the U.S. Army a tentative 
roster of physicians who would form 
the professional staff of a contemplated 
1,000-bed general hospital. 

When the Japanese attacked Pearl 
Harbor, the doctors of the 105th knew 
that the call to duty was imminent. They 
were alerted on Christmas Eve and given 
two weeks to close out their practices 
and buy uniforms and equipment. 

Among those who got the call to serve 
was Robert Snow 35. "After Pearl Harbor, 
I knew it was just a matter of time until I 
would join the action," he says. "I had 
already bought my own uniform and foot 
locker from an Army store in Boston. On 
Christmas Day, my wife and I were 

This article is the first in a two-part series on 
the role of HMS in World War 11. The second 
article will appear in an upcoming issue. 



attending a cocktail party. We were just 
about to head home when one of the 
guests stopped me and told me that 
another member of the 105th had received 
his orders the day before. 'They've been 
trying to reach you by telephone all day 
long!' he told me. Because I was the junior 
man in my practice, I had spent all of 
Christmas Day doing rounds at no fewer 
than six different hospitals. I immediate- 
ly phoned Dr. John Newell [HMS Class of 
1930] and asked, 'Are we really going to 
war?' 'You sure are!' came his reply, and a 
great cheer of excitement went up at the 
party when I relayed the news. It's hard to 
describe the level of patriotism and 
morale that existed in that era." 

Snow and his fellow members of the 
105th traveled to Fort Lewis, Washing- 
ton, where they were joined by nurses 
and enlisted personnel. They also 
acquired aU the equipment necessary to 
get a general hospital up and running, 
and then proceeded to San Francisco, 
where they picked up the bulk of their 
medical hbrary from local booksellers. 
There they found themselves housed on 
the outskirts of the city in a large build- 
ing formerly used for hvestock and sur- 
rounded by an old greyhound racetrack. 
Anxious to escape these accommoda- 
tions, which they none too affectionate- 
ly dubbed "The Cow Palace," the men 
speculated feverishly about where they 
might be headed and chafed with impa- 
tience to join the action. 

Danger on the High Seas 

The men of the I05th got their wish when 
they set sail on the U.S.S. West Point, a con- 
verted luxury Hner, on May 19, 1942. Their 
relief mingled with nervousness as they 
passed under the Golden Gate Bridge. 
The West Point was considered the queen 
of the merchant marine — the newest, 
finest, and largest American luxury finer 
afloat — ^but also the most important 
naval prize sought by Japanese planes and 
German submarines. The men of the 
105th knew that her precious cargo of 
medical personnel and suppUes made the 
West Point all the more tempting a target. 




But the expected naval escort never mate- 
rialized; the West Point relied on her great 
speed for her own protection. 

Although the West Point had been 
intended for elite North American pas- 
senger service, conditions on board 
were anything but glamorous. The cots 
on which the men slept. Snow recaUs, 
were barely two feet vs/ide and stacked 
four deep so that 16 medical officers 
found themselves and their duffel bags 
crammed into a single cabin equipped 
with one latrine. The ship had been 
designed for 500 passengers, but it car- 
ried 3,500 men to Austraha. By the time 
it arrived, many were suffering from 
severe colds, and a fair number were 
hospitalized \\dth pneumonia, includ- 
ing the 105th's commanding officer. The 
lack of antibiotics combined with the 
southern hemisphere's winter condi- 
tions made for a rough landing for many. 



HARVARD MEDICAL ALUMNI BULLETIN • SUMMER 2000 




The tough conditions persisted 
ashore. No one seemed prepared for the 
arrival of the 105th. The men initially 
camped out in the bitterly cold Aus- 
trahan winter in tents with dirt floors; 
their first dinner consisted of cheese and 
hardtack biscuits that had apparently 
been baked during World War I, judg- 
ing from the 1918 date stamped on their 
containers. Reaching their final destina- 
tion required a rail journey of some 1,300 
miles with only bare wooden seats for 
beds. Because the Australian railways 
used different, and sometimes incom- 
patible, gauges, the men had to stop 
twice and switch over to new trains on 
separate tracks and unload, by hand, 
every last piece of hospital equipment. 
By the time the men arrived near Gatton, 
at the Queensland Agricultural College, 
which had been evacuated and turned 
over to the U.S. Army for the purposes of 




UNDER THE BIG TENT: Wounded soldiers from the New Guinea campaign were 
cared for in open-air settings, such as this medical ward at Biak (top left). The 
arrival of the new beer rations always raised morale among the men of the 105th 
(top right). The officers of the surgical service of the 105th posed for a photograph 
in May 1 945 (above). Hartwell Harrison '33 (seated third from the left), chief of the 
surgical service, invented fever therapy as a treatment for drug-resistant gonorrhea. 



SUMMER 2000 • HARVARD MEDICAL ALUMNI BULLETIN 



45 



^ I Some of the doctors' most noteworthy wartime accomplishments- 



establishing a hospital, they were both 
reheved and anxious to get to work. 

Hospital Down Under 

The members of the 105th estabhshed 
their hospital on 80 acres in the center of 
a large valley. By the time construction 
was complete, the base resembled a 
small city of nearly 700 people, including 
60 doctors, 115 nurses, nearly 500 enlist- 
ed men, and a handful of civiUans. They 
converted classrooms into wards and 
operating rooms, and they built separate 
structures to house the Red Cross, phar- 
macy, pathology laboratory, patients' 
mess haU, medical supply warehouses, 
and other essential departments. 

Turning an agricultural coUege into a 
hospital posed unique challenges. Mem- 
bers of the radiological service spent 
their first month at Gatton instaUing 
two large x-ray machines. They took 
great care to ensure that the fluoroscop- 



ic room they created was Ught-tight; to 
their chagrin, as they later discovered 
during the humid summer months, they 
had also made the room nearly airtight. 

Although everyone in the 105th had 
to contend with the winds that 
whipped ceaselessly across the fields of 
Gatton, those in the laboratory service 
had the hardest time of any. The cur- 
rents carried with them not just the 
chill of the Austrahan winter, but also a 
hardy sample of the bacterial and 
mycological flora of West Queensland, 
which deposited themselves on the 
frustrated pathologists' agar plates. 

There wasn't much for the doctors of 
the 105th to do, at first. Patients were 
mercifully few and their ailments typical 
of those that tended to afflict young men 
Hving in military camps. But soon 
enough, the hospital began to fulfill a vital 
need when fighting broke out in New 
Guinea. The surgical service admitted 
many soldiers with soft tissue wounds 



caused by shrapnel and small-caUber- 
rifle and machine-gun fire. Their injuries 
were often complicated by compound 
fractures. The medical service treated 
many cases of malaria, dysentery, pul- 
monary tuberculosis, hookworm, scrub 
typhus, salmonella infections, typhoid 
and paratyphoid fever, and filariasis. 

Doctors in the 105th also saw a fair 
number of neuropsychiatric cases, which 
they treated in closed wards located 
behind the stockade. Recalls Arthur Pier 
'39, "The patients were mosdy soldiers in 
their early twenties, and many of them 
were very scared. They didn't want to go 
to war and were literally sick at the 
prospect. There was just a tremendous 
amount of neurosis." 

Once the casualties began to pour 
in, Gatton became a very busy 1,000- 
bed hospital abutted by a tent city 
in which another 1,000 soldiers were 
undergoing rehabihtation so that they 
could be returned to combat duty. The 




LOCAL HEROES: The native people of New Guinea bravely undertook the task of transporting v/ounded soldiers, by litter, 
from the frontlines to the portable hospitals. They v/ould carry the injured for distances of up to 12 miles. 



HARVARD MEDICAL ALUMNI BULLETIN • SUMMER 2000 



rehab hospital patients were taken on 
daily five- to fifteen-mile hikes to whip 
them back into fighting shape. They 
also learned water discipline — one can- 
teen of purified water per day, and if the 
weather was too hot, too bad! Men 
were either being treated or on duty; 
there simply was no in-between status. 
Although some of the men were afraid 
to return to battle, even more were eager 
to see action. Snow remembers one sol- 
dier who, before the war, had undergone 
a radical mastoidectomy that had left 
him deaf in one ear. "Now, son, how in 
the world did you manage to enlist?" 
Snow asked him. "Well, doc," the man 
replied, "I wanted to get in so badly that 
I didn't let them examine the bum ear." 
Snow saw another patient who had been 
born blind in one eye, a problem that 
became apparent during target practice; 
Snow drummed him back stateside. "We 
were all eager to be able to contribute 
something to the war," he says. 

infection and innovation 



Medical innovation represented one of 
the 105ths most significant contribu- 
tions to the war effort. Although Snow, 
at age 90, enjoys reflecting on a life lived 
through what he terms "the golden age 
of infectious disease," he vividly recalls 
the hardships of the World War II era. 
Although it had been discovered years 
earlier, penicillin did not come into use 
until relatively late in the war. 

Arthur Pier's primary job was dealing 
with malaria, which was often fatal. 
"We treated patients with intravenous 
quinine," he says. "We also saw a fair 
amount of dengue fever and other tropi- 
cal illnesses not famiUar to us from back 
home in Boston. One especially nasty 
disease was scrub typhus, which was 
transmitted by the bite of a mite and was 
often deadly — it caused a kind of 
encephahtis. In New Guinea, we even 
stumbled across a leper colony populat- 
ed by indigenous people. It was quite 
shocking and horrifying to see how the 
disease had just eaten away the ear and 
nasal cartilage of many of these individ- 




JUNGLE FEVER: Members of the 4th Portable Surgical Hospital about to depart 
for Hev/ Guinea in June 1 943. In the middle is Lieutenant Arthur Pier '39. 



uals. Although it wasn't possible for us 
to follow up because our unit moved on, 
we administered a hefty dose of peni- 
cillin to each of them, in the hope that it 
might do some good. PeniciUin was our 
new miracle drug and because it was so 
new, it seemed magically effective in 
treating strep and staph and other bugs." 

By 1944, penicillin had also become 
the standard treatment for gonorrhea; 
this came as a great relief to Army offi- 
cials who had been alarmed by a strain 
of gonorrhea that proved resistant to 
sulfa drugs. For two years, though, 
drug-resistant cases of gonorrhea were 
treated by an innovative method devel- 
oped by a doctor in the 105th, Hartwell 
Harrison '33. Harrison's "fever therapy," 
carried out in so-called fever cabinets, 
was used to cure more than 300 cases. 
So successful was his method that it 
was widely copied by other general 
hospitals during the war. 

Because the gonorrhea organism is 
fragile, Harrison's idea was to eliminate 
it without kiUing its host. His therapy 
called for patients to be dressed in loin- 
cloths, hooked up intravenously to flu- 
ids, and have rectal thermometers 
inserted to monitor their temperatures. 
They would then be enclosed within 



wooden "fever cabinets" under infrared 
lamps that raised their body tempera- 
tures to a sweltering 105 degrees — for 
12 agonizing hours. Patients quickly 
became delirious. 

"Boy, that was rough on those guys!" 
remembers Snow. "But once they sur- 
vived the treatment, they were cured." 
Fever therapy for sulfonamide-resistant 
gonorrhea was instituted in October 
1942 and continued until it was 
replaced by the advent of penicillin 
therapy ki 1944. 

Medics Under Fire 



Some of the HMS doctors' most note- 
worthy wartime accomplishments — 
and toughest medical challenges — 
took place in the heat of battle. Some 
doctors of the 105th found wartime 
medicine too similar to the careers they 
had left behind in their Boston prac- 
tices. "I had been dying to get into the 
war," recalls Arthur Pier. "I couldn't 
understand why any doctor would 
want to stay at home. But being around 
a general hospital was boring; it was 
too much like civilian life back in 
the States. I volunteered for the 4th 
Portable Surgical Hospital because I 



SUMMER 2000 • HARVARD MEDICAL ALUMNI BULLETIN 



^ I Without laundiy facilities, sur 



m 



wanted to be close to where the action 
was." When the 105th eventually moved 
from Gatton to a place called Biak on 
the north side of New Guinea to sup- 
port the Alhed invasion of the Philip- 
pines and Japan, Pier and others like 
him got their chance. 

The mobile surgical unit was a revo- 
lutionary new concept at the time. Each 
unit was set up with tents and equip- 
ment to accommodate 25 patients 
within 10,000 yards of the battle line. In 
reahty, these units sometimes crept up 
to within 750 yards of the combat zone. 
Patients could be worked on only 30 to 
40 minutes away from the spot where 
they had fallen wounded. The injured 
were transported on htters carried by 
four New Guinea native people, accom- 
panied by four more as relief. The 
patients would be brought first to the 
portable, then to the evacuation hospi- 
tal, and, finally, to the general hospital 
for long-term care and rehabihtation. 

But estabhshing surgical wards in 
the jungle was no easy task, There was 
no open, dry ground on which to set up 
a hospital unit. The 5th Portable made 
camp on an abandoned muddy battle- 
field too sodden to be burned for sani- 
tizing purposes. Downpours would 
occasionally wash into view the rotting 
corpses of Japanese machine gunners 
trapped inside their pillboxes. 

To make matters worse, sniper fire, 
sometimes drawn by a surgeon's flash- 
light, posed a constant danger. Geneva 
cross markings failed to protect the 
doctors at work. One entire portable 
was pinned down for hours by machine 
gun fire at Buna, and the other survived 
strafing by enemy planes. One harrow- 
ing time, the Japanese broke through 
between the 4th and 5th Portables. 

The men who served in the portable 
units had to battle natural threats as 
well. They lost weight due to the sultry 
temperatures and constant sweating, 
and many of them suffered from jaun- 
dice and diarrhea. Mosquitoes, lizards, 
fhes, biting ants, and stinging scorpi- 
ons added to the hazards of jungle life. 



HARVARD MEDICAL ALUMNI BULLETIN • SUMMER 2000 




M^iili U\ iild liM h Md kriltfiiVik iiU i kl 1 11 i 



>er aprons. 




iA 





Jungle Surgery 

Inside their rudimentary operating 
rooms, which were fashioned out of 
tents and furnished with tables and 
stands made of pandan and bamboo, 
HMS doctors rehed on sMl, luck, and 
ingenuity to care for their patients. Their 
equipment consisted of a basic surgical 
kit to which they had added special 
instruments; one officer transformed a 
two-tipped mortician's syringe, some 
rubber tubing, and empty sahne flasks 
into a portable suction apparatus, which 
proved quite an effective tool in abdom- 
inal and skuU procedures. 

Sanitation posed the greatest chal- 
lenge. All instruments were boiled to 
start the day, and kits for surgery were 
taken from this reservoir. One man was 
assigned full-time to cleaning and 
resterihzing instruments. Each operat- 
ing area contained a homemade table for 
sterile supplies, solutions, reserve 
instruments, and a bucket of sterile 
gloves and towels in bichloride of mer- 
cury. Surgeons used gloves wet and, 
without laundry facihties, did not wear 
operating gowns, but instead performed 
surgery clad in shorts, shoes, and rubber 
aprons. In most cases, except when they 
operated on abdominal or head wounds, 
the surgeons worked alone. During the 
nighttime blackouts, they rehed on hght 
from kerosene lanterns and battery 
flashlights. The door flaps would be 
sealed with blankets and a messenger 
posted outside to run errands and keep 
the door closed. 

Surgical procedure also followed very 
different rules from those the HMS doc- 
tors were accustomed to back in Boston. 
They would expose the wound and pre- 
pare the operative field by applying soap 
solution and alcohol, but the patients' 
clothes were never removed entirely 
because no replacement uniforms were 
available. Most patients had not bathed 
for days or even weeks, were covered in 
mud and sand, and suffered from fungal 
infections of the skin, yet precious anti- 
septic was apphed to the skin only 
around head or abdominal wounds. 



Despite these extraordinary condi- 
tions, HMS doctors achieved remark- 
ably low mortality rates; for one of the 
portables, the operative mortality in 
202 cases was 2.5 percent. 

A Season in Hell 



Reflecting on their experiences in the 
I05th from their perspectives as physi- 
cians, both Arthur Pier and Robert Snow 
wax philosophical. "War is a savage, hor- 
rible business, no doubt about it," says 
Pier, who served in the European theater 
as well as the Pacific, and was only 40 
yards away when Hider took his own 
hfe. "In Europe, I dealt with a lot of war 
prisoners. We gave our enemies the same 
medical treatment as our own wounded, 
but the Germans certainly didn't treat 
their captives very well. The Norwegian 
prisoners were just full of tuberculosis. I 
also saw quite a bit of starvation." 

"In war, neither side is immune from 
atrocities," says Snow. "Some Japanese 
prisoners preferred to starve to death in 
the jungle rather than face capture 
because they feared torture. I know 
that we never saw any Japanese prison- 
ers of war in Australia; rumor had it 
that they were interrogated, put on 
planes and, when those planes landed, 
there were no longer prisoners aboard; 
they had been pushed out mid-fhght." 

Yet despite the harsh realities of the 
Second World War, Arthur Pier, like his 
HMS colleagues who served in the 
105th, and like his peers in what has 
been dubbed "the greatest generation," 
has no regrets: "In so many ways, the 
war seems unreal, like a dream world. 
But the lessons we learned so long ago 
stiU stand. We can never let a monster 
hke Hitler get out of control hke that 
again. We paid a high price for our vic- 
tory, but we gave our children and 
grandchildren the gift of peace, and 
that, as anyone who has hved through a 
war firsthand can tell you, is a very great 
gift indeed." ■ 

Beverly Ballaro is assistant editor of the 
Harvard Medical Alumni Bulletin. 



SUMMER 2000 • HARVARD MEDICAL ALUMNI BULLETIN 



49 



by Paul C. Zamecnik 



"THAT YOUNG MAN IS POURING HIS MEDICAL 

education down the drain," a professor at Case 
Western Reserve University, where I had just 
interned for a year, told a friend of mine. It was 
August 1939, and my bride and 1 were about to 
embark on a Moseley Traveling Fellowship 
from Harvard to the famous Carlsberg Labora- 
tory, an international center in Copenhagen 
for the study of proteins and histochemistry. 

We drove from Ohio to New Hampshire, 
then jumped on a train to Montreal, 
equipped with steamer trunk, handbags, and 
a combination radio -phonograph. The next 
morning, we were greeted at the gangplank 
of the S.S. Brant County of Bergen, Norway, 
by Captain Brevik, a short, red-cheeked, 




.«*w 



ON THE 




h 1 939, when the author eft for Copenhagen on a Harvard traveling fellowship^ 






wm 



Ml 



UNINVITED GUEST 

German soldiers salu 

King Christian X on 

his morning ride in 

Copenhagen. In 1940, 

no resistance movement 

had been formed in 

Denmark yet, and the 

German occupying power 

was eager to sustain an 

image of politeness. 






'i»'IPiw'^#?S!|, 



'..^A(-_'S^v*;_ 



■A,!vl. t 









;^^v 




i,*V.i*^.< 







i 



'M^'-.r^: 




history stood poised on the edge of events that would di 



'orld. 



^ . Our greatest fear was not that we'd be caught in the war, but that th( 



\'iolaceous-nosed, gold- toothed, roly- 
poly, middle-aged Norwegian. He 
grasped Mary by both hands and offered 
us the bridal suite on this 5,000-ton 
freighter bound for Bristol, England and 
Antwerp, carrying a total of 12 passen- 
gers. The price was $60 one-way to Bris- 
tol, $65 to Antwerp. The time, 12 days. 

Eight of the passengers were Ger- 
mans, Nazi Bund members, returning 
to their homeland after being expelled 
from Canada for promoting Party activ- 
ity. One was a theater projectionist who 
showed movies of the new German 
movement at a Bund in his spare time. 
Another was a zither player at the beer 
hall that served as a center for the Bund 
in Montreal. A third was a middle-aged 
widow who spent her time knitting 
sweaters for German soldiers. 

Each evening, we gathered in the 
captain's quarters for radio news of the 
international situation, increasingly 
grave with each passing day. If war 
broke out while we were on the open 
sea, Bergen would send a special wire- 
less message giving us our destina- 
tion — the nearest neutral port. Once 
we were more than halfway across the 
ocean, it would likely be Antwerp. Our 
greatest fear was not that we'd be 
caught in the war, but that the boat 
would return to Montreal, depriving us 
of an exciting year in Europe. 

When the ship reached Bristol, it 
took its place at the end of a long queue 
of freighters waiting to unload. We 
spent a day in Bristol, which was hav- 
ing a mock air-raid in concert with the 
French. War was clearly imminent, and 
Captain Brevik advised us to leave the 
ship, cross England by train, and take a 
ferry to Denmark. 

Several days later, on September 1, we 
were awakened by a loud radio report in 
the common room of our Danish hotel. 
We found a group of somber people 
clustered around the radio. The Ger- 
mans had just invaded Poland. There 
was great speculation as to whether 
England and France would follow 
through with their resolve that, if an 
invasion occurred, they would declare 
war. Two days later, both countries did 



HARVARD MEDICAL ALUMNI BULLETIN • SUMMER 2000 



indeed declare war, and a shiver ran 
through Copenhagen. 

A Growing Field 

The next day, we bicycled to the Carls- 
berg Laboratory, and I was astonished to 
find it to be so small. It looked more Kke 
the residence of an affluent count than 
the home of so much outstanding work 
in protein chemistry. A set of marble 
stairs led to a foyer, at the top of which 
stood Kai Linderstrom-Lang, the new 
director of the laboratory. He was a blue- 
eyed, straw-hatred man with a half-smil- 
ing face. He constantly held a partially 
smoked cigar, which he examined from 
time to time as if to ponder the effect of 
gra\dty on the growing ash. His long 
white coat bore streaks of red, yeUow, 
and green under the left armpit. He 
greeted us diffidently, and mentioned 
that although there had been plans to fiU 
the laboratory with foreigners that year, 
only one other xdsitor, another Ameri- 
can, had turned up. A Dutchman had 
sent a cake as an apology. 

"Your best bet is to go home," Linder- 
strom-Lang said, "but that's up to you." 

"What kind of chemistry does he do," 
I later asked the American, "to produce 
those unusual streaks under the arm?" 

"Oh," he said, "he paints in his spare 
time and wipes his brush under his arm." 

Under Linderstrom-Lang and his 
associate, Heinz Holter, the Carlsberg 
Laboratory had recently become the 
center for the new field of histochem- 
istry, and I decided with their consent 
to try to measure the respiration of a 
single cell, using the Cartesian diver 
technique developed at the laboratory. 
This research involved tissue taken 
from the cardiac muscle of ten-day-old 
embryonic chicks that was then incu- 
bated, dissected out, and planted. For 
many years, however, the Carlsberg 
Laboratory's chemical division, where 
we were located, had specialized in 
research on yeast, and the concentra- 
tion of yeast in the laboratory air was 
too high for successful tissue culturing, 
particularly since the sterile hood had 
not yet been developed. 



An arrangement was made with 
Albert Fisher, crown prince of the emerg- 
ing tissue culture field, who had his own 
institute in Copenhagen, on the other 
side of the city. My wife, Mary, became 
tired of sightseeing and joined Fisher's 
wife in growing tissue cultures, which we 
carried across the city for metaboffc 
experiments for the next nine months. 

In the Blink of an Eye 

On April 9, 1940, the first fine day of the 
Danish spring, dawn was just brighten- 
ing the skyhght of our ateher when the 
loud drone and repeated Doppler effect 
of many airplanes flying low back and 
forth over Copenhagen aroused us from 
a heavy sleep. I looked out at the cloud- 
less blue sky and saw a dozen bombers 
receding in the distance, wheeling, then 
crisscrossing the city in a V-formation. I 
muttered to Mary that Denmark had no 
such planes. As they passed over our 
building, it shook slightly with the 




3oat would return to Montreal, depriving us of an exciting year in Europe. 



soundwaves, and the Nazi insignia was 
clearly visible on the lower wings of the 
planes. "The Danes won't Kke this," I 
murmured as I watched heads appearing 
from the v^ondows of nearby rooftops. 

On the next approach of the planes, 
objects appeared to drop — not bombs, 
we could see, because they had begun to 
spread out and flutter down — but 
rather leaflets. I leaned far out over the 
sloping slate roof and puUed in a green 
handbill, printed on coarse cheap paper. 
It was written in imperfect teutonic 
Danish, which I translated briefly as: 

"Notice to the Danish People; The 
German Government and German 
Army have as of this day occupied Den- 
mark and Norway to protect them from 
the British, who have been harassing 
and mining the territorial waters of 
these countries. We urge the Danish 
people to remain quiet, to conduct daily 
business as usual, and to cooperate with 
the German authorities, sent here to 
safeguard our common interests. Fur- 



ther instructions will come via the Dan- 
ish radio." The note was signed "Von 
Kaupitsch, German Commander." 

We quickly dressed and ran down 
five flights of stairs of the ponderous old 
gray stone apartment building, then 
entered Fredericksberg Alle, one of 
Copenhagen's main streets. How, we 
wondered, could a country be taken 
over in the bhnk of an eye? Was this the 
hghtning-hke end to our year in the fairy 
tale land of Hans Christian Anderson? 

Fredericksberg Alle was usually 
deserted at 6:30 in the morning. On this 
day, though, people gathered on the 
street corners, asking each other in sub- 
dued tones if it was true — had Den- 
mark already been taken over? Had 
there been fighting? Why had no gun- 
shots been heard? Where were the Ger- 
man soldiers? How could they possibly 
have occupied Norway also? And where 
was the British fleet? 

The Bcrlingskc Tidmdc — the daily news- 
paper — ^was not at the kiosks that morn- 



ing, and the Danish radio was sHent. The 
place to find out the truth was at the 
Danish Pentagon, down near the water- 
front. We joined a sHent parade walking 
there, to confirm sadly that German sol- 
diers were standing guard outside, with 
an occasional Danish uniform also visible. 
People living near the harbor had heard 
naval guns just before dawn, then sHence. 

Demise of the Toy Soldiers 

At Langlinie, near the rock on which the 
Httle bronze mermaid sits watching the 
harbor, we could see German troop ships 
unloading, vtdth open-sided staff cars fuU 
of officers in dress uniforms zooming up 
a ramp then off onto the highway at high 
speed — clearly not expecting resistance. 
Then came motorcycles with sidecars, 
the drivers wearing battle dress and hel- 
mets, the sidecars manned by soldiers 
with their hands on mounted machine 





IN THE LAB: The Carlsberg 
Laboratory (left), looked 
more like the residence of 
an affluent count than the 
home of outstanding protein 
chemistry research. Kai 
Linderstrom-Lang (above) 
served as director of the 
laboratory. 



SUMMER 2000 • HARVARD MEDICAL ALUMNI BULLETIN 



53 



parade seemed to be forming on the main avenue, and we stood 



guns. A dozen coal barges bearing Ger- 
man flags filled the harbor. They had 
been in Copenhagen port for several 
days, and German soldiers had emerged 
from them just at dawn, the vanguard of 
the invasion force. 

We walked over to the Amalienborg 
Palace, whose entrance was normally 
guarded by two tall, handsome Danish 
soldiers wearing red uniforms with 
crisscrossed white straps and tall fur 
shakos, carrying gleaming old-fash- 
ioned muskets, standing in front of a 
tiny house meant to shade them. No toy 
soldiers were there today, only a hori- 
zontal tracery of bullet holes across the 
stone walls of the palace toward, 
through, and past the guard houses, 
which were splashed with blood. 

As we walked toward the center of 
Copenhagen, we saw motorcycles with 
machine gunners in readiness at major 
intersections. A parade seemed to be 
forming on the main avenue leading from 



the harbor, and we stood on the sidewalk 
alongside a long string of Danes, silent 
and funereal, as first rows of soldiers on 
motorcycles, then footsoldiers with guns 
strapped across their backs, then open 
lorries with officers in fuU parade dress 
with short swords at their sides, moved 
slowly from the harbor toward the cen- 
ter of town. The parade reached a traffic 
hght, which turned red during the pro- 
cession. A sporvogn — a streetcar — 
clanged its bell angrily and persistendy, 
the parade stopped, the streetcar passed 
across the intersection, the light turned 
green, and the victory march took off 
again, while the spectators snickered. 

As the parade passed, Georg Hevesy, 
the father of radioactive tracers, nudged 
me. "Guess what I've been doing," he 
whispered. He had dissolved Max Von 
Laue's Nobel Prize medal in aqua regia, 
then he had set the glass container on a 
high laboratory shelf for the duration of 
the war. Von Laue, the German pioneer 



in x-ray diffraction, had given the medal 
to Hevesy for safekeeping, since the 
Nazis were collecting all precious met- 
als. (After the war, Hevesy precipitated 
out the gold and had the medal recast in 
Sweden.) Hevesy whispered in conspir- 
atorial tones, "Come to our house for tea 
on Sunday. I have something for you." 

Matters of Fate 



Back at the Carlsberg Laboratory, we 
opened the door at the foot of the stair- 
case leading to the main floor of the lab- 
oratory. Understrom-Lang was standing 
in the foyer, his usual half-smoked cigar 
with its long white ash stlLl attached in 
one hand, the shock of hair hanging 
down over one of his deUquescent eyes. 
He spoke slowly and waved one arm 
toward us. "Now go home, Pasteur and 
Sweetie Pie," he said, using his pet names 
for us, then turned and walked slowly 
away, adding, "and leave us to our fate." 



OPROP! 

Til Danmarks Soldater og Danmarks Folkl 



111.' 



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og I'raiilirigrls UlagUi 



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eridntret Tysklnnii Krig.i.. 

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■fKiJes og Jorfor cr niii.ilre farligc for rraiikiiRet og Kiigliiiid. 1 dct Bnnb. at det iklii; vildr viurc 
for TvikTun.l. al lundc optrjude sUirJct noU iniol duiii. 



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rilorinlr Fnrvn 
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iiid l>ar England blaiidl anili-l sindig kr.i 



' givi 



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Fiinoud. Sinn rrkl«-ric- ,- U i,i ^ 
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linnvipu >il K^g^«l>ul;plolt&. Dii vn ydcrlig AnledniDg ikk< 
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oll.^ nndvcudigt^ Slott'imukter vwl Norges Kyst 

loTKtn Vcrdcnskrig til UlyVkc for liclc Mpj 
n ikkc var ^■illig lil at In wig holdc (ilbaki 
1 Pn]»iriBpppr*. 
I danvkc og ilon tiorvlti 



■i\f" 



NOTICE TO THE DANISH PEOPLE: 
As German planes flew over- 
head on April 9, 1940, green 
handbills printed on coarse 
paper floated to the ground. 
In imperfect teutonic Danish, 
they urged the Danes to remain 
quiet, to conduct daily business 
as usual, and to cooperate 
with the German authorities. 



HARVARD MEDICAL ALUMNI BULLETIN • SUMMER 2000 








FOX IN THE CHICKEN COOP: 
German units marched to 
the Copenhagen Citadel on 
April 20, 1 940, for a parode 
in honor of Hitler's birthday. 



We paused to look at the windowsill 
on which the incoming mail was 
stacked. That very day there was an 
envelope from the Finney- Howell 
Foundation with a check for $1,000, my 
stipend for the second six months of my 
feUowship. Nothing from the Moseley 
Fellowship — that $250 for the second 
six months wouldn't arrive untH the 
spring of 1946, six years later, making 
its way mysteriously to Boston, post- 
marked by stamps of both the German 
and British censors. We pocketed the 
check, wondering how negotiable it 
would be, and wandered into our labo- 
ratory to examine our tissue cultures. 

Kai Morgensen, a postdoctoral fel- 
low, came in wearing cavalry pants 
with a red stripe down the side, and 
riding boots, partly covered by a long 
white laboratory coat. "I shot a Ger- 
man!" he shouted elatedly. "We were 
called out during the night, ren- 
dezvoused at a strategic approach near 
the outskirts of Copenhagen. As a col- 



umn of German soldiers approached, 
we fired, then had to retreat because of 
their superior strength." 

"Morgensen," we said, "take off 
those siUy pants and hide your gun." 

Mission Impossible 

As we bicycled back toward town center, 
we met a dusty column of German sol- 
diers on bicycles riding steadily toward 
the center of town, sweat dripping out 
from under helmets and gray woolen uni- 
forms, guns strapped diagonally across 
their backs. Rumor had it that they had 
been dropped by parachute between 
RoskUde and Copenhagen, their bicycles 
in two halves, which they bolted together 
once they hit the ground. We wandered 
into our favorite restaurant. Across from 
us were two German army officers, legs 
stretched out at a small table, engaged in 
a relaxed supper. For the first time we 
decided to speak in Danish, which would 
be less conspicuous than Enghsh. 



What should we do, we wondered, 
during the evening of such a fateful day? 
Just around the corner was a cinema, so 
we stood in line for the seven o'clock 
show. In front of us were two German 
soldiers in battle dress, with guns in 
their holsters and hand grenades hang- 
ing on little chains from their upper 
pockets. Drums Along the Mohawk was 
playing, featuring Claudette Colbert 
and Henry Fonda. We watched Indians 
and settlers engaged in mortal combat, 
their words dubbed in Danish. 

It was dark when we left the theater, 
incredibly dark on this first night of the 
imposed blackout. We stumbled on the 
curbstone, then walked in the middle of 
the street until we recognized the huge 
bulk of our building. We climbed the 
five flights of darkened stairs to our 
apartment. Outside the door we found 
a bucket of sand, a hard hat, and a note 
stating that, since we Uved on the top 
floor, I had been appointed the hus vagi 
My duties were to chmb onto the sloping 



SUMMER 2000 • HARVARD MEDICAL ALUMNI BULLETIN 



55 



^ The German consulate had sent our passports to Berhn. After a I 



slate roof, douse any firebombs with 
sand, and rouse the occupants below if 
things got out of hand. 

The Color of Money 

The next few days we pondered what to 
do with my fellowship check. The Danish 
banks, now supendsed by the Germans, 
would not touch it. Fortunately, two 
unanticipated sources of funds sprang 
out of nowhere. That Sunday afternoon, 
when I attended tea at Georg Hevesy's 
house, he leaned over my chair, put one 
arm around me, and with the other 
shpped a thick envelope into the inside 
pocket of my coat. "Look at it later," he 
said, before moving on to converse with 
his other guests. The envelope contained 
5,000 Danish kroner, the equivalent of six 
months' salary, which we were free to use, 
with the understanding that we wotild 
send the equivalent to Harold Urey the 
father of heavy isotopes, at Columbia 
when we returned home — for safekeep- 
ing for Hevesy 

The second windfall came that same 
week, when the chief of the American 
consulate telephoned and asked if I were 
free to visit him at his office. Linderstrom- 
Lang, who had taken the caU, was dumb- 
founded, as were Mary and I, since we 
had recently been given circular treat- 
ment — in and very quickly out — at the 
consulate, where we were informed that 
our check could not be cashed. The con- 
sul general greeted me warmly, ushered 
me into his spacious office, and smoothed 
out a telegram on his desk. "Are you a 
friend of Cordell HuU?" he asked. 

Hull was the U.S. secretary of state, 
and so I answered slowly and warily, 
"Why yes, I know him." I should, of 
course, have said I knew of him. The 
telegram read: "Inquiring welfare, 
financial needs and future plans of Paul 
and Mary Zamecrdk." It was signed 
"Cordell Hull." 

"Do you have financial needs?" the 
consul general asked genially. 

"Well," I said casually, "it would be 
helpful if you could arrange to cash our 
fellowship check." 



"Let me see how much money we 
have in our safe," he responded, pro- 
ceeding to turn the dials appropriately 
to open the small floor safe in his office. 
"I can spare $500," he said. "That's 
about all we have. But I'U plan for you 
to get the other $500 at the Danish 
National Bank." We later learned that 
our friends and family members had 
been pulling strings back home. 

The next morning, I met an aide from 
the consulate. We proceeded to an 
inconspicuous side door of the Danish 
National Bank, presented a note to a 
German guard in uniform, and were 
admitted. We passed through a large 
room filled with perhaps two dozen 
tables, with huge piles of money in large 
denominations from various countries 
thrown in disarray on each table. There 
were British notes in the hundreds, 
French francs, Danish kroner, German 
marks, and other currencies I did not rec- 
ognize. As I walked behind our escort, 
my foot bumped into a thick stack of 
British five -pound notes, which I picked 
up and threw onto the pile on one table. 
It occurred to me later that such a wind- 
fall would have kept us happy for a 
year — and whose money was it, anyway? 
In a small room leading off this larger 
one, a German officer counted out five 
American one-hundred-doUar bills and 
handed them to me. 

Missed Connection 



The day after the German occupation, 
the German consulate had sent our 
passports, along with those of other for- 
eigners, to Berlin. After a months wait, 
we were given 24 hours in which to 
leave Denmark. On the day before our 
departure, we received a message that 
Niels Bohr wished to see us. Bohr, a fer- 
vent anti-Nazi, was the primary source 
of information on the new atom spht- 
ting reaction that would lead to the cre- 
ation of the atomic bomb. He asked if I 
would take a letter to Henry Smythe, 
the Princeton author of the pioneer 
report on atomic explosions. I reached 
out my hand, and for a second we both 



held the envelope. Then he said, "By the 
way, are you leaving via Petsamo?" 

"Oh no," I replied, "Petsamo is cut 
off. We're travehng through Germany 
and Italy." His expression hardened, 
and his hand retracted the letter. 

"Oh, in that case," he said, "I won't give 
it to you — it would be too dangerous." 

"We don't mind," I said. "I know of a 
good place to hide it." 

"No," he answered, "just teU Henry 
Smythe and Harold Urey that I am all 
right for the present — not to worry 
about me." What was in that letter I 
never knew, only that fate kept me from 
being the courier for what might have 
been an important piece of history. 

Homeward Bound 



The following day, our Danish friends 
waved goodbye as we boarded a train 
for Gedser, at the southern tip of Den- 
mark. There we transferred to a boat 
destined for the German side of the 




HARVARD MEDICAL ALUMNI BULLETIN • SUMMER 2000 



month's wait, we were given 24 hours in which to leave Denmark. 



Baltic. Akeady German soldiers were 
leaving Denmark for a rest back home. It 
was clear that the crack divisions of the 
German army had not been assigned to 
the Danish invasion; instead, a number 
of older troops had been appointed for 
this so-called guard duty. 

Our connecting train then sped to 
Berlin, where we had paid to be met by a 
guide who would then transfer us to a 
train for Munich. Berlin was under a 
blackout, however, and no guide turned 
up to meet us. By the time we had coHect- 
ed our baggage, the few taxis available 
were gone. We managed to make our way 
to Anhalter railroad station, where we 
learned that no trains were leaving for 
Munich that night. Our only recourse 
was to spend the night in the Hotel 
Berhner. The station was full of young 
soldiers with guns and packs, jostling 
each other and us as they searched for 
their units. Few civihans could be seen. 

In the morning, a loud radio awak- 
ened us. At breakfast every ear was 



A WATCHFUL EYE: Near the 
rock on >vhich the bronze 
Little Mermaid >vatches the 
harbor, observers could see 
German troop ships unload- 
ing. The officers on board 
seemed relaxed and clearly 
did not expect resistance. 




^-.. 




tuned to the radio, which could be 
heard throughout the hotel dining 
room. During the night, German forces 
had been sent into Holland and Bel- 
gium, to protect them, as the official 
word had it, from the British, who were 
about to invade the low countries. 

By noon on May 10, we found a train 
for Munich, largely occupied by German 
businessmen. En route, a group of 
inspectors accompanied by an armed 
guard entered each compartment. Inside 
a box in a rack above our heads was the 
radio-phonograph that we had brought 
from Montreal. The inspector asked us 
to bring it dov^oi and cautioned us stern- 
ly, "Radios are forbidden." 

"Oh," we said. "Phonograph!" 

He opened the top, saw the disc and 
arm pickup, and having never before seen 
a combination radio-phonograph, smil- 
ingly said, "Oh, phonogmfic, that's OK." 

At Munich, we transferred to a train 
going through the Brenner Pass. On 
drawing into the station at Brennero, 
we could see that the German half of 
the station was blacked out, while the 
Italian half remained brightly ht. We 
proceeded without event to Genoa, to 
meet a U.S. liner scheduled to leave the 
Mediterranean later that month. We 
had confirmed tickets, but at the 
steamship headquarters we found that 
our tickets had been sold again and 
that we had no booking after all. 

A huge, disorganized crowd filled the 
ticket office, and it took several hours of 
squeezing to reach the counter. A Danish 
clerk apologized, but said that the situa- 
tion was hopeless, and that our best bet 
was to wait for the S.S. Manhattan, due in 
Genoa in two weeks. He advised us to 
enjoy Italy, and not to worry He assured 
us that Italy would be neutral during the 
war. We were secredy delighted to have 
a chance to visit Florence. There we pho- 
tographed a demonstration against the 
British by a large group of ItaMans declar- 
ing that the Mediterranean was an Ital- 
ian sea, and that they wanted control of 
Gibraltar, Malta, Suez, and Djibouti. The 
ambivalent pohce cracked a few heads 
before the crowd dispersed. 



Capri was deserted, other than the 
occasional American. We climbed to 
Anacapri, kayaked on the far side of 
Capri, and had lunch on a lull overlook- 
ing the Mediterranean, where we 
watched a huge caimon being installed 
on a movable track, so that it could be 
hidden in the side of the mountain. 

We boarded the S.S. Manhattan in 
Naples, its first Itahan destination on 
returning from the United States, and 
proceeded to Genoa. Here we spent half a 
day searching for our luggage among the 
mountains of unorganized baggage in the 
warehouse of the American hne. Many 
refugees from the war were refused pas- 
sage because of overbooking, and the 
ship's swimming pool was used for a dor- 
mitory. Inexphcably, however, large ship- 
ments of machine tools from Eastern 
Europe were at the same time being 
loaded onto the S.S. Manhattan, occupying 
areas that could have been used for extra 
passengers. The captain gave a stern 
warning that all passengers should 
remain within sound of the boat whisde. 
Three blasts were our signal to hurry 
back, since the ship might weigh anchor 
within an hour. Despite the warning, a 
group of Canadian priests went to Milan. 
The three blasts sounded, and although 
they returned moments before debarka- 
tion, the gangplank had already been 
pulled and they were left behind. 

By the time the S.S. Manhattan reached 
Gibraltar, Italy had declared war and 
had begun a military mop-up of an area 
bordering the south of France. Rumor 
had it that the Itahans had waited for 
the Contc di Savoia, the pride of its 
transatlantic Une, to dock, to avoid its 
capture by the British. Just outside of 
Gibraltar, we were spotted by a German 
submarine, which exchanged messages 
and then allowed our passage to New 
York. Our question of the morning of 
April 9, 1940 had been answered — it 
was indeed the end of a fairy tale year. ■ 

Paul C. Zamccnik 36 is the Collis P. Huntington 
Professor of Oncologic Medicine, Emeritus at 
HMS and honorary physician and senior scien- 
tist at Massachusetts General Hospital. 



SUMMER 2000 • HARVARD MEDICAL ALUMNI BULLETIN 



57 




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